Cleveland Clinic Study Finds Better Survival Rates With Bypass Surgery
Than Angioplasty in High-Risk Patients

People with severely clogged coronary arteries coupled with other serious health problems lived longer if they underwent surgery to bypass the blocked vessels rather than less-invasive percutaneous procedures to reopen them, new Cleveland Clinic research shows. Full results of the study will be published in the May 18 issue of Circulation.*

For the study, Cleveland Clinic researchers examined five-year mortality rates in a group of patients with high-risk characteristics, such as coronary artery disease in multiple vessels coupled with diabetes, high blood pressure or heart failure.

Patients who had percutaneous coronary interventions (PCI), such as angioplasty or stenting, to reopen clogged arteries had mortality rates nearly two times greater than did patients who had coronary artery bypass grafting (CABG) surgery, after accounting for important differences in risk factors between the two cohorts. CABG surgery restores blood flow to heart tissue by taking a healthy vein or artery from the leg, arm, or chest and moving it outside the heart to bypass the clogged coronary vessel.

The results were somewhat surprising in light of recent technological and medical advancements in PCI, which is considered significantly less invasive than open-heart surgery, said Sorin J. Brener, M.D., first author of the Circulation study.

“Bypass surgery tended to have a greater benefit in the sickest patients,” said Dr. Brener, a staff cardiologist at The Cleveland Clinic. “Surprising results can be the most beneficial because they allow us to offer the best treatment options to patients, especially when they are contrary to conventional wisdom.”

Investigators reviewed the medical records of more than 5,100 patients who had CABG and more than 870 who had PCI. All patients were treated at The Cleveland Clinic between 1995 and 1999. Although overall survival rates were not significantly different between the two groups, researchers found important differences after adjusting for certain risk factors — such as diabetes, hypertension, smoking, body weight and other factors — to compare the groups in-depth.

The one- and five-year mortality rates (pre-adjustment) were 5 percent and 16 percent, respectively, for the PCI treatment group, and 4 percent and 14 percent for the CABG treatment group. After adjusting for additional risk factors, PCI was associated with significantly higher death rates in all categories.

Study investigators noted several points to consider in light of these findings. First, operative mortality rates were significantly lower at The Cleveland Clinic than the national average, which may affect applicability to other centers. The Cleveland Clinic’s in-hospital mortality is 1.1 percent compared to 3.3 percent in the database of the Society of Thoracic Surgeons, which includes data on more than 100,000 cardiovascular surgeries. In addition, PCI is likely to be the better treatment for lower-risk heart disease patients because of its shorter recovery time, less-invasive nature and lower blood loss.

The Cleveland Clinic Heart Center is the recognized world leader in the diagnosis and treatment of cardiovascular disease. U.S. News & World Report has ranked The Cleveland Clinic No. 1 in the nation for cardiac care each year since 1995 and among America’s Ten Best Hospitals each year since 1990.

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