Bypass better for advanced heart disease
A Sunnybrook study has found that despite advances in angioplasty and stent placement, coronary artery bypass graft surgery remains the preferred therapy for patients with advanced coronary disease.
Published in the latest issue of the Journal of the American Medical Association, researchers looked at 13 randomized controlled trials and five meta-analyses on bypass surgery and percutaneous interventions such as angioplasty, as well as current clinical guidelines over the last seven years.
For the most advanced coronary artery disease, and for those patients with diabetes, coronary artery bypass surgery was confirmed as the most appropriate treatment. Advanced heart disease included unprotected left main disease where there is more than 50 per cent blockage in the left main coronary artery; blockages in two or more coronary arteries; blocked arteries in patients with diabetes and left ventricular dysfunction.
Percutaneous interventions were recommended for patients with less complex coronary artery disease, or where there is a higher risk of adverse events from surgery.
"We're not saying that angioplasty hasn't made major strides, but the data suggests that surgery is still the preferred course of treatment for heart patients with multi-vessel blockages and patients with diabetes," says Dr. Stephen Fremes, principal investigator, professor at the University of Toronto and cardiac surgeon at the Schulich Heart Centre, Sunnybrook Health Sciences Centre. "This data confirms our current approach of treating those with serious coronary disease with bypass surgery over angioplasty as patients generally have better outcomes."
Full media release
Bypass surgery better than angioplasty for advanced heart disease
TORONTO, November 18, 2013 - A Sunnybrook study has found that despite advances in angioplasty and stent placement, coronary artery bypass graft surgery remains the preferred therapy for patients with advanced coronary disease.
Published in the latest issue of the Journal of the American Medical Association (early online release at http://jama.jamanetwork.com/article.aspx?articleID=1779540), researchers looked at 13 randomized controlled trials and five meta-analyses on bypass surgery and percutaneous interventions such as angioplasty, as well as current clinical guidelines over the last seven years.
For the most advanced coronary artery disease, and for those patients with diabetes, coronary artery bypass surgery was confirmed as the most appropriate treatment. Advanced heart disease included unprotected left main disease where there is more than 50 per cent blockage in the left main coronary artery; blockages in two or more coronary arteries; blocked arteries in patients with diabetes and left ventricular dysfunction.
Percutaneous interventions were recommended for patients with less complex coronary artery disease, or where there is a higher risk of adverse events from surgery.
"We're not saying that angioplasty hasn't made major strides, but the data suggests that surgery is still the preferred course of treatment for heart patients with multi-vessel blockages and patients with diabetes," says Dr. Stephen Fremes, principal investigator, professor at the University of Toronto and cardiac surgeon at the Schulich Heart Centre, Sunnybrook Health Sciences Centre. "This data confirms our current approach of treating those with serious coronary disease with bypass surgery over angioplasty as patients generally have better outcomes."
Dr. Fremes points to the SYNTAX Score, a unique tool to score the complexity of coronary artery blockages, as an important factor in determining a patient's candidacy for percutaneous intervention and also the EuroSCORE or STS score addressing a patient's operative risk.
"A heart team approach should evaluate the complexity of each patient's coronary artery disease, patient comorbidities and patient preference," says Dr. Fremes. "Our goal was to provide evidence-based recommendations in the treatment of heart disease so that patients receive the most effective treatment."
