DALLAS, Oct. 7. -- A long-term study shows that individuals whose coronary arteries are obstructed and who are treated with angioplasty have more heart-related deaths than those who undergo bypass surgery.
The higher rate, however, is due to deaths of people with diabetes, according to a study in today's American Heart Association journal Circulation.
"Death rates are higher in persons with diabetes since they have more coronary heart disease and more heart attacks," says Bernard Chaitman, M.D., professor of medicine and chief of cardiology at St. Louis University School of Medicine.
The findings are results of the Bypass Angioplasty Revascularization Investigation (BARI) Randomized Trial, which is based at the University of Pittsburgh and sponsored by the National Heart, Lung and Blood Institute (NHLBI).
Angioplasty is a nonsurgical procedure that uses a balloon catheter to dilate or widen an obstructed part of a coronary artery. Coronary bypass surgery is an open-heart operation in which arteries or veins are taken from another part of the body and surgically attached to the coronary arteries. The attached vessels circumvent the blocked coronary artery.
After a five year follow-up study of 1,829 patients, the heart disease death rate in patients treated for angioplasty was 8 percent compared to 4.9 percent of those having had bypass. On the other hand, no significant differences in death rates were found among nondiabetic patients within the study.
"The long-term outcome of patients with multivessel (more than one vessel involved) coronary disease is not compromised among nondiabetic patients when angioplasty is chosen as the initial treatment strategy," says Chaitman.
"However, more research is needed to explore new advances in angioplasty such as stents and strategies of early aggressive intervention in diabetics."
Advances in medical therapy of diabetes may also improve the heart death rates among diabetic patients, the report says.
A cautious approach should be pursued toward recommending new interventions for people with diabetes with advanced heart disease until these approaches are tested and understood, adds Chaitman.
Contact: Dr. Chaitman can be reached at (314-577-8890)