Bypass and Angioplasty Research

Multiple Studies Show that Bypass Surgery and Balloon Angioplasty Do Not Reduce Risk of Heart Attack or Improve Death Rate

"With remarkable clarity and consistency, . . . studies show that routine angiography and revascularization do not reduce the incidence of reinfarction or death. . ." Quoted from:

Lange RA, Hillis, LD. Use and overuse of angiography and revascularization for acute coronary syndromes (editorial). N Engl J Med 1998;338(25):1838-1839.

REFERENCES

1. Boden WE, O'Rourke RA, Crawford NIH, et al. Outcomes in patients with acute nonQwave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy. N Engl J Med 1998,338:1785-92.

2. Williams DO, Braunwald E, Thompson B, Sharaf BL, Buller CE, Knatterud GL. Results of percutaneous transluminal coronary angioplasty in unstable angina and non-Q-wave myocardial infarction: observations from the TIMI IIIB Trial. Circulation 1996;94:2749-55.

3. Anderson HV. Cannon CP, Stone PH, et al. One-year results of the Thrombolysis In Myocardial Infarction (TIMI) IIIB clinical trial: a randomized comparison of tissue-type plasminogen activator versus placebo and early invasive versus early conservative strategies in unstable angina and non-Q wave myocardial infarction. J Am Coll Cardiol 1995;26:1643-50.

4. The TIMI Study Group. Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction: results of the Thrombolysis in Myocardial Infarction (TIMI) phase II trial. N Engl J Med 1989;320:618-27.

5. Terrin ML, Williams DO, Kleiman NS, ct al. Two-and three-year results of the Thrombolysis in Myocardial Infarction (TIMI) Phase II clinical trial. J Am Coll Cardiol 1993;22:1763-72.

6. SWIFT (Should We Intervene Following Thrombolysis?) Trial Study Group. SWIFT trial of delayed elective intervention v conservative treatment after thrombolysis with anistreplase in acute myocardial infarction. BMJ 1991;302:555-60.

Study Shows that Bypass Surgery Offers neither Better Survival nor Symptomatic Benefit in Patients with Stable Angina

A 22 year follow-up of 682 patients assigned to surgical and non-surgical groups between 1972 and 1974 showed that, "beneficial and life-saving effects of coronary artery bypass surgery are confined to selected subgroups of patients for limited duration. . .In the long term, an initial bypass protocol offers neither survival nor symptomatic benefits."

Peduzzi P. Kamina A, Detre K. Twenty two-year follow-up in the VA cooperative study of coronary artery bypass surgery for stable angina. Am J Cardiol 1998 Jun 15;81(12):1393-1399.

Study Shows that Bypass Surgery and Angioplasty do not Improve Mortality After Heart Attack

A recent study reported in the New England Journal of Medicine compared the death rate in of two sets of patients: The first set of patients had either balloon coronary angioplasty and/or coronary bypass surgery after having a heart attack (myocardial infarction, MI). The second set of patients had no invasive cardiac procedures after having a heart attack. The 1-year mortality was identical in both groups. This study shows that that bypass surgery and/or angioplasty do not reduce the risk of death after a heart attack.

Tu JV, Pashos CL, et al. Use of Cardiac Procedures and Outcomes in Elderly Patients With Myocardial Infarction in the United States and Canada. N Engl J Med. 1997;336(May 22):1500-1505.

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