After an exercise stress test and coronary angiography, you may be told that your chest pain is caused by narrowed coronary arteries. Your doctor may recommend either angioplasty or a coronary artery bypass graft (CABG), but the final decision will be up to you.
It's tempting to choose angioplasty, which is much less invasive, has lower in-hospital mortality, and lets you return to work almost immediately. But a long-recognized, major disadvantage of angioplasty is that restenosis (narrowing of the artery again) occurs far more often with angioplasty than with CABG. Still, angioplasty has better outcomes when stents are used to prop arteries open. Newer, drug-eluting stents -- they release drugs that reduce the chance the arteries will become blocked again -- lower the chance of restenosis even more.
Angioplasty seems a reasonable choice to unblock a single coronary artery but the decision is more difficult if more than one artery is blocked. A large study from New York indicates that the decision should depend heavily on the number of obstructed arteries and the sites of obstruction. The study involved 37,212 bypass patients and 22,102 angioplasty patients, all of whom had narrowing in multiple arteries. As in earlier studies, the need for a second angioplasty or bypass surgery was much greater in patients who initially had angioplasty. However, most striking 3 years after the procedure was the significantly greater survival of the patients who had bypass surgery compared to those who had angioplasty.
One explanation for the superiority of CABG is that angioplasty is directed only against a recognized "culprit" atherosclerotic plaque, whereas bypass surgery bypasses not only the target plaque but also other plaques in the artery that could be responsible for future heart attacks. The researchers also stress the importance of aggressively managing risk factors like high cholesterol, high blood pressure, and cigarette smoking to prevent progression of disease in the arteries that are not bypassed.
It's tempting to choose angioplasty, which is much less invasive, has lower in-hospital mortality, and lets you return to work almost immediately. But a long-recognized, major disadvantage of angioplasty is that restenosis (narrowing of the artery again) occurs far more often with angioplasty than with CABG. Still, angioplasty has better outcomes when stents are used to prop arteries open. Newer, drug-eluting stents -- they release drugs that reduce the chance the arteries will become blocked again -- lower the chance of restenosis even more.
Angioplasty seems a reasonable choice to unblock a single coronary artery but the decision is more difficult if more than one artery is blocked. A large study from New York indicates that the decision should depend heavily on the number of obstructed arteries and the sites of obstruction. The study involved 37,212 bypass patients and 22,102 angioplasty patients, all of whom had narrowing in multiple arteries. As in earlier studies, the need for a second angioplasty or bypass surgery was much greater in patients who initially had angioplasty. However, most striking 3 years after the procedure was the significantly greater survival of the patients who had bypass surgery compared to those who had angioplasty.
One explanation for the superiority of CABG is that angioplasty is directed only against a recognized "culprit" atherosclerotic plaque, whereas bypass surgery bypasses not only the target plaque but also other plaques in the artery that could be responsible for future heart attacks. The researchers also stress the importance of aggressively managing risk factors like high cholesterol, high blood pressure, and cigarette smoking to prevent progression of disease in the arteries that are not bypassed.
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