Bypass Beats Angioplasty for Patients with Diabetes

During angioplasty, a balloon-tipped catheter is inserted into a blocked heart artery to widen it and boost blood flow. Often a stent is inserted into the heart artery during the procedure to help keep the artery open.

Surgeons perform bypass surgery by taking a healthy blood vessel from inside the chest wall or the lower leg and reattaching it above and below the blocked heart artery. This also improves blood flow by allowing blood to bypass the blockage.

Researchers compared the five-year survival rates among more than 105,000 people aged 66 or older with heart disease who underwent coronary artery bypass surgery involving multiple heart arteries or angioplasty to open multiple blocked heart arteries. Of these, 33% also had diabetes.

The overall five-year survival rate was 74.7% among those who had bypass and 71.8% after angioplasty. The increase in survival with bypass was significantly greater among people with diabetes, heart failure, or peripheral vascular disease (blocked blood vessels outside of the heart and brain). Smokers, too, may live longer after bypass compared to angioplasty, the study suggests.

"The findings confirm that bypass is better than angioplasty for people with diabetes," says Henry Ting, MD. He is the chair of the conference and a cardiologist at the Mayo Clinic in Rochester, Minn.

But there are other variables involved in making this decision. For example, bypass is riskier and involves a longer hospital stay and recovery period. "With angioplasty, you can go home the next day," he says. "You have to weigh your personal preferences, too. It is not just about duration of life, it is about quality of life."

Kirk Garratt, MD, the clinical director of interventional cardiovascular research at Lenox Hill Hospital in New York City, agrees, "For a lot of patients, angioplasty is an excellent alternative." "But neither bypass nor angioplasty will help a really sick person live a lot longer." "The best choice must be made on an individual basis after a careful discussion with your doctor."

The new report is slated for presentation at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions 2012 in Atlanta.