Which is Superior, Angioplasty or Bypass?

I always hear people around me debating about the superiority of angioplasty and coronary artery bypass grafting. Some insisted angioplasty is good because it carries lesser risk than bypass, while others argued that bypass could prevent heart patients from getting a repeat procedure or surgery over a longer period.

Coronary Angioplasty (or angioplasty, in short) is a technique to treat coronary heart disease and angina. It involves opening narrowed or blocked blood vessels known as coronary arteries of the heart.

Angina is chest pain or discomfort that occurs when an area of the heart muscle does not get enough oxygen-rich blood. A person with angina may feel pressure or squeezing in the chest. The pain may also occur in the shoulders, arms, neck, jaw, or back.

While angioplasty is a procedure, coronary artery bypass grafting (in short, bypass) is a type of heart surgery. It is sometimes called CABG ("cabbage"). During the operation, the surgery reroutes, or "bypasses," blood around clogged arteries by using a segment of a healthy blood vessel from another part of the body to improve blood flow and oxygen to the heart.

In October 2007, a new study revealed that bypass is indeed better than angioplasty at relieving chest pain and preventing the need for a repeat procedure. On the other hand, both angioplasty and bypass could provide patients with heart disease who need a procedure or surgery to clear their clogged coronary arteries the similar 10-year survival rates.

1.2 percent of patients undergoing bypass and 0.6 percent of those being treated with angioplasty incurred strokes. Angina was relieved over a 5-year period in 84 percent of bypass patients comparing with 79 percent of the angioplasty group.

Meanwhile, the researchers also found that 43 percent of patients treated with angioplasty and less than 10 percent of patient undergone coronary bypass required repeat procedures after 5 years.

Nevertheless, as noted by the researchers, emergence of new and refined techniques has made such a comparison to “remain a moving target”. In fact, new studies have already begun to investigate how the availability of drug-coated stents used in angioplasty affects the comparative efficacy of these techniques.

Avandia May Help Prevent Progression of Blockages After Heart Surgery!

It is not uncommon that a drug that is effective in treating one disease may end up a culprit that triggers another unwanted medical condition. Avandia, a diabetes drug, is a good example.

During May 2007, researchers reported in the New England Journal of Medicine that Avandia was found to raise the risk of a heart attack by 43 percent. This set off a stream of controversy, and even forced the regulators to require Avandia carry strong warnings about the heart attack risks.

However, a new study indicated that Avandia might prove to be effective in preventing the progression of blockages after heart surgery.

The study, dubbed “Victory”, was carried out by researchers from Laval University and Hospital Laval in Quebec City, evaluated the benefit and safety of the drug, genetically known as rosiglitazone, in preventing atherosclerosis progression in patients with Type-2 diabetes 1 to 10 years after surgery. Their findings were presented on April 1, 2008 at the American College of Cardiology meeting in Chicago.

The researchers also examined the metabolic effect of the drug. As such, the researchers claimed that this is the first study to look at the cardiovascular and metabolic affects of the drug. 193 patients at 8 centers in Canada and Spain were evaluated and the trial concluded there were no adverse events. Results also showed that the weight gain in patients was subcutaneous fat, not abdominal fat, which is more dangerous.

Although “Victory” is only a moderate size trial, its results provide reassurance about the safety of rosiglitazone. Rosiglitazone has been under strong attack because of the heart attack risk when comparing with Pioglitazone, the other glitazone compound. Pioglitazone, is sold as Actos in the United States and Glustin in Europe.

Other studies that involve a larger number of patients are also evaluating Avandia and the findings will further define its role in patients with Type-2 diabetes and coronary disease.

Over the next 10 years, it is expected that the number of patients with Type-2 diabetes, the most common form of diabetes, and coronary disease will increase dramatically.

Each year, more than 500,000 patients with Type-2 diabetes undergo coronary artery bypass grafts and most will have one or more bypasses using a vein taken from the leg. Sad to say, the grafts of 50 percent of the patients become re-obstructed after 10 years.

Coronary Bypass Or Stents, Which One To Choose?

When a person is diagnosed with blockages in the coronary arteries, there is always a dilemma to face. Should he or she undergo bypass operation or choose the drug-eluting stents? This is certainly not an easy decision to make!

A group of researchers from the State University of New York, Rensselaer published their findings in the January 2008’s New England Journal of Medicine. In the paper, they indicated that patients with several blockages in their coronary arteries should choose to undergo bypass grafting instead of having the new generation of drug-eluting stents inserted because the mortality rates are lower.

The study compared outcomes of nearly 10,000 patients with multiple coronary lesions who were treated with drug-eluting stents and almost 7500 similar patients who underwent coronary artery bypass grafting.

After adjusting the presence of other illnesses, the chances that patients who died within 18 months were approximately 25 percent lower for those with the coronary bypass operation than those with insertion of drug-eluting stents. Estimated rates of heart attacks and need for another procedure also ranked bypass grafting higher than stenting.

The results more or less confirm that coronary artery bypass grafting remains the standard for car for patients who require clearing multiple coronary blockages. However, stents may still be an alternative for patients who are at high risk for surgical complications, or when the patient chooses a less invasive option instead.

Post-CABG Complications May Be Influenced By Poverty!

What is CABG? It stands for coronary artery bypass grafting. Research showed that people living in socially and economically deprived areas may have a higher risk of developing cardiovascular complications following CABG.

Researchers studied a British community undergoing CABG, and found that as a result of socio-economic deprivation, the post-CABG outcomes may be influenced by reduced access to specialist cardiac services, lower uptake of non-invasive cardiac investigations and revascularization procedures, and lower uptake of cardiac rehabilitation programs.

This is the first study to show that socio-economic deprivation is an independent predictor of poor cardiovascular outcome. Researchers, therefore, suggested that a higher incidence of baseline risk factors in people of low socio-economic status, greater psychological factors such as social isolation and stress in this group, and differences in those given and seeking treatment might explain the above findings.

Heart Surgery In Octogenarians

Age should be a consideration when predicting postoperative outcomes. Therefore, heart surgery patients in their 80s cannot be compared to youngers in terms of postoperative outcomes.

This was the findings of a study conducted by a community hospital in Cincinnati, Ohio, USA on the outcomes of 522 octogenarians and 7,204 non-octogenarians who underwent coronary artery bypass grafting (CABG) or valve surgery between 1993 and 2001.

Octogenarians have a higher risk of death by 72 percent, neurological complications by 51 percent, and are more likely to undergo re-operation to treat bleeding by 49 percent.