Angioplasty OK for Major Heart Artery

April 1, 2008 (Chicago) -- Angioplasty may be a perfectly good option for opening up blockages in the major artery that provides most of the blood to the heart, South Korean researchers say.

They studied people with blockages in the left main coronary artery. It supplies blood to the left side of the heart muscle, which is the side that pumps fresh blood to the rest of the body. Current guidelines call for these patients to undergo bypass surgery.

"We focused on all-cause mortality and found no statistical difference between and bypass surgery," says Seung-Jung Park, MD, director of interventional cardiology at Asan Medical Center in Seoul.

But angioplasty patients who received stents -- tiny wire mesh tubes used to prop open an artery -- were more likely than bypass patients to have to undergo procedures to reopen arteries that had reclogged, he says.

Still, the hope is that some patients with seriously blocked arteries may be able to avoid the more invasive bypass surgery, Park tells WebMD.

Angioplasty vs. Bypass

In angioplasty, a balloon at the end of a long tube is threaded through an artery in the groin. The doctor shimmies the probe up through the patient's leg and right into the arteries of the heart. The balloon is inflated at the spot where the vessel has narrowed, opening it.

To keep the vessel open, doctors often add a stent to the end of the balloon catheter. Some stents are coated with drugs to further reduce the risk an artery will reclog.

In bypass surgery, cardiac surgeons harvest a segment of a healthy blood vessel from another part of the body and use it to bypass the clogged artery or arteries, rerouting the blood to improve blood flow to the heart.

For the new study, Park and colleagues analyzed data on 2,240 patients with left main coronary artery disease treated at 12 medical centers in Korea. Of these, 318 were treated with angioplasty and bare-metal stents, 784 were treated with angioplasty and drug-coated stents, and 1,138 underwent bypass surgery.

The findings were released at a meeting of the Society for Cardiovascular Angiography and Interventions being held in conjunction with the American College of Cardiology. They were simultaneously published online in The New England Journal of Medicine.

During three years of follow-up:

• The rates of death, heart attack, and stroke were similar in the two groups.
• Patients treated with bare-metal stents were nearly six times as likely to need a repeat procedure to reopen the affected vessel than those who underwent bypass surgery. 
• Patients treated with drug-coated stents were about three times as likely to need a repeat procedure.

The next step is a clinical trial pitting bypass against angioplasty with drug-coated stents in patients with left main artery disease, Park says.