The average person with multiple diseased arteries in the heart does slightly better following coronary artery bypass surgery than after having stents inserted, a new study suggests, but the optimal procedure varies by patient.
Researchers found slightly more heart patients survived at least five years after bypass surgery - 74 percent, versus 72 percent of those who had a stenting procedure, known as angioplasty.
However, people who had no diabetes or heart failure and were non-smokers tended to have better outcomes with angioplasty than with more invasive surgery, the study team reported Monday in the Annals of Internal Medicine.
"It's good to say, ‘On average people do better with this drug or this procedure,'" said Dr. Mark Hlatky, a healthy policy and cardiovascular medicine researcher at Stanford University in California.
"But if we could only target the people who would get the most benefit, we'd probably make better decisions and maybe save money," he said.
For their study, Hlatky and his colleagues tracked the records of 105,156 people on Medicare, the government health insurance program for the elderly, who had bypass surgery or received stents between 1992 and 2008. Patients from each treatment group were matched by age and the year they had their procedure.
The researchers calculated the average patient lived 19 days longer after bypass surgery than stenting. People with diabetes, heart failure and peripheral artery disease, as well as those who smoked, were especially likely to benefit from bypass surgery.
But the rest of heart patients - as many as 41 percent - were predicted to do better after angioplasty, they found.