Study sees lower death risk with bypass surgery versus angioplasty for older heart patients

Older patients with clogged heart arteries may have a little lower death risk over time if they get bypass operations instead of angioplasty and stents to fix the problem, new research suggests. It's not the kind of study that gives conclusive evidence, but doctors say it gives a "real world" look at how people fare in ordinary practice. As such, it could tip the balance toward surgery for patients considering the choice, especially because research already shows bypass gives a better and longer lasting result for people with multiple blockages. In a bypass operation, doctors move healthy blood vessels from other parts of the body to detour around clogged arteries supplying blood to the heart. Angioplasty treats the problem via a tube pushed through a blood vessel. A tiny balloon is inflated to flatten the clog and a mesh scaffold, a stent, is placed to prop the artery open. Researchers compared these approaches using records on 190,000 Medicare patients with two or three blockages - the largest study ever of this issue. Death rates were similar one year after either treatment. But after four years, nearly 21 percent of the angioplasty patients had died versus about 16 percent of those who had bypass surgery. Results were discussed at an American College of Cardiology conference in Chicago and published online by the New England Journal of Medicine