EMBARGOED FOR RELEASE: 3 p.m. (CT) Tuesday, March 4, 1997
Media Advisory:
To contact George Sopko, M.D., M.P.H.,
call the NHLBI Communications Office at 301/496-4236.

Five-Year Outcomes Similar Between Bypass Surgery and Angioplasty Initial limitations vary

Survival rates and quality of life are similar after five years whether a patient undergoes angioplasty or coronary bypass surgery, according to an article in this week's issue of The Journal of the American Medical Association (JAMA).

The study was conducted by researchers from the Bypass Angioplasty Revascularization Investigation group (BARI), including George Sopko, M.D., M.P.H., from the National Heart, Lung and Blood Institute (NHLBI) in Bethesda, Md. They followed 1829 patients at 18 clinical centers for five years after the patients underwent either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA).

Patients were evaluated 4 to 14 weeks after entering the study, again at six months, and then annually through five years. The researchers compared the patients' symptoms, exercise test results and use of medication. Patients answered questionnaires to evaluate quality of life factors including limitation to jobs, housework, sex life, relationships, hobbies, interests and vacations.

While the five-year outcomes were similar, there were differences prior to reaching the five-year mark.

CABG is an operation to circumvent narrowed or blocked coronary arteries by grafting on additional blood vessels to receive blood flow. PTCA is a technique for opening narrowed or blocked arteries by inserting a balloon-tip catheter to dialate the artery, according to the AMA's Encyclopedia of Medicine.

Among those who were employed, a greater percentage of PTCA patients were able to return to work by the 4 to 14 week follow up point, 55 percent compared with 36 percent of the patients who underwent CABG. CABG patients were also more likely to report limitations with their jobs, housework and social lives. After one year, though, return to work rates increased to 72 percent for CABG patients and 69 percent for PTCA patients.

The researchers write: "The longer recovery time needed following bypass surgery is reflected in the PTCA patients' earlier return to work and the CABG patients' more frequent reporting of limitations with housework and social activities at their early follow up. Otherwise, standard quality of life outcomes and behavioral risk factors were similar for the two treatment groups."

During the first five years after the initial procedure, PTCA patients had a greater number of additional procedures. They also had a greater likelihood of angina and exercise induced ischemia during the first three years. But the researchers say, "Over time, the treatment differences in angina and exercise induced ischemia diminished, due to a return of symptoms among CABG patients and to incremental surgical procedures among PTCA patients." Angina pectoris is pain in the chest and arms or jaw, due to a lack of oxygen to the heart muscle, while ischemia is an insufficient supply of blood to a specific organ or tissue.

PTCA patients were more likely to be treated with anti ischemic drugs, and more bypass patients reported using diuretics through the follow up period. CABG patients were more likely than PTCA patients to use digitalis early on, but the difference was no longer significant by the fifth year. The use of lipid lowering drugs was significantly higher for angioplasty patients.

The researchers conclude: "Continued clinical and electrocardiographic follow up of the BARI patients is important ... If mortality and morbidity remain similar, quality of life and functional outcomes will remain important considerations for the choice of initial strategy."

Among the patients enrolled in the study between August of 1988 and August of 1991, 73 percent were male. The average age was 61.5 years. Forty-one percent had triple vessel coronary artery disease, 55 percent had a history of heart attack, nearly half had high blood pressure, and almost one in four had a history of diabetes. # For more information: contact the AMA's Science News Department at 312/464 5374. AMA web site: http://www.ama assn.org

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