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Studies question heart bypass, angioplasty method
NEW ORLEANS (AP) - Two new studies could change care for hundreds of thousands of heart patients each year. One finds that bypass surgery has been overrated for many people with very weak hearts from clogged arteries and previous heart attacks. The other challenges the way artery-opening procedures have been done for decades.
It was the first big test of doing balloon angioplasty to clear heart arteries through an arm instead of a leg. Complications were fewer with the arm method and at hospitals that did this more often, deaths, heart attacks and other big problems were lower, too.
He is a leader of the American College of Cardiology conference in New Orleans where the studies were presented on Monday.
The bypass study’s surprising result is “a blockbuster,” McNulty said. The operation did not improve survival for heart failure patients who already were taking medicines to control risks like high cholesterol and high blood pressure.
Clogged arteries cause about two-thirds of the 6 million cases of heart failure in the United States. The heart isn’t getting enough blood and enlarges as it grows weaker from working too hard. Doctors often advise bypass to improve blood flow, but the new study calls that into question.
The study involved 1,200 heart failure patients in 22 countries, mostly men around 60 years old. Most had suffered a heart attack in the past. All were taking medicines they should for heart risks, and half were assigned to also get bypass surgery.
Doctors assumed bypass would cut deaths by 25 percent. But after nearly five years, about the same number in each group had died, said study leader Dr. Eric Velazquez of Duke University Medical Center.
One hundred people in the drug-alone group wound up having a bypass; 55 who were supposed to get the operation never did. Results on only those who had the treatment they were initially assigned suggested that bypass surgery did improve survival.
But its risks were evident, too. For the first two years, there were more deaths among those given surgery versus the others.
“If you don’t have an expectation to outlive that two-year window,” surgery is not a good idea, Velazquez said.
The National Heart, Lung and Blood Institute paid for the study, and Abbott Laboratories provided some medicines. Results were published online by the New England Journal of Medicine.
The other study involved more than 7,000 people in 32 countries getting an angiogram _ a diagnostic test to look for blockages _ followed by angioplasty to open any clogs found.
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