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News1994December › Angioplasty: no better than bypass › December 1994

Angioplasty: no better than bypass

Angioplasty, fast becoming the operation of choice for those with a heart condition, is probably no more effective than the bypass surgery it is superceding

Angioplasty, fast becoming the operation of choice for those with a heart condition, is probably no more effective than the bypass surgery it is superceding.

Even though balloon angioplasty or percutaneous transluminal coronary angioplasty, to give it its full title has been used since 1977, it has never been properly tested against bypass surgery.

Now two clinical trials have been published which show the rush to embrace angioplasty may have been premature. One study, carried out by Spencer King et al from the Emory University School of Medicine in Atlanta, Georgia, concludes that the choice can be left to the patient and the quality of life he wants afterwards (N E J Med, 20 October 1994).

In a peer review of the two papers, David Hillis and John Rutherford at the Southwestern Medical Center in Dallas, Texas, point out that surgery is not even necessary if the patient has normal functioning of the left side of the heart. "Lest we forget, medical therapy relieves angina in many patients regardless of the severity of disease, and its influence on survival is similar to that of surgery", they write in the same issue.

The studies discovered that only half of the patients who took part 5,118 in the King study, and 8,981 patients in the study by Christian Hamm et al were suitable for angioplasty. Both studies agreed that bypass is a more dangerous procedure, with a greater risk of a fatal heart attack on the operating table, but that the patient who survives can enjoy a longer period without further medication. The angioplasty patient, however, needs to go on a course of drugs, and may need a repeat operation.


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