When Heart Disease Is Severe, You’ll Probably Do Better With Bypass

A look at quality of life after surgery versus angioplasty with stenting
When Heart Disease Is Severe, You'll Probably Do Better With Bypass

If three of your coronary arteries or your left main coronary artery are diseased, you’re better off with bypass surgery than angioplasty with stenting.

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That’s what a 2017 study of participants in the 2013 SYNTAX trial reveals.

SYNTAX documented fewer adverse outcomes among patients with severe disease five years after coronary artery bypass grafting (CABG) versus five years after angioplasty with a drug-eluting stent. (The first-generation stent was coated with the drug paclitaxel to prevent scarring.)

The new study shows that long-term quality of life for these patients, who had either three-vessel or left main coronary artery disease, was also better after bypass surgery.

“Both CABG and angioplasty with drug-eluting stents were associated with substantial and sustained quality-of-life benefits over five years of follow-up,” study author Mouin S. Abdallah, MD, points out. “But CABG provided greater relief from angina at five years, primarily among patients with anatomically complex disease.”

The new research shores up support for CABG as the preferred treatment for complex coronary artery disease.

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Health status improves over time

The study followed 1,800 SYNTAX participants for five years after they had bypass surgery or angioplasty with stenting.

Researchers evaluated their health status at the start of the study and then one, six, 12, 36 and 60 months after treatment, using questionnaires and surveys.

After five years, CABG patients fared significantly better than patients who had angioplasty with stenting in terms of angina frequency, physical function and other measures. The more complex the disease, the less angioplasty and stenting were able to relieve their symptoms.

“This reinforces the recommendation that CABG should be strongly preferred for patients with high severity scores,” notes Dr. Abdallah.

Other key study findings

Among other notable findings from the 2017 study:

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  • Bypass surgery yielded significantly greater benefits in heart and general health measures at both one and five years.
  • CABG was better at relieving angina even when age, diabetes and type of complex coronary disease (three-vessel or left main) were considered.
  • Relief from angina occurred as early as one month after surgery or angioplasty with stenting, and largely endured throughout the five years.
  • Patients’ health status was restored faster after angioplasty with stenting than after CABG.

“These long-term health status differences were comparable to what we found in the 2013 FREEDOM trial, which compared outcomes in patients with diabetes and multivessel heart disease after either CABG or angioplasty with a drug-eluting stent,” says Dr. Abdallah.

Angioplasty still an option for some

This evidence clearly makes CABG the treatment of choice for high-risk patients, he notes.

However, for patients whose heart disease is less complex, angioplasty with a drug-eluting stent remains an option.

“If your heart disease is less severe, it’s best to seek help from a center offering comprehensive heart care,” says Dr. Abdallah. “There, a team of experts can explore and weigh both options for you, taking your preferences and priorities into account.”

Dr. Abdallah and other SYNTAX investigators call for future trials to explore whether treatment with newer drug-eluting stents might yield benefits comparable to CABG for patients with complex heart disease.

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