Surgery Better than Drugs to Improve Blood Flow to Heart

A study has found that there are fewer deaths among patients who undergo coronary artery bypass surgery or angioplasty (2%) to improve blood flow than among patients given drug therapy (6.7%). The findings were reported in the May 26 online issue of Circulation.

In the observational study, researchers compared the survival benefits of both medical and revascularization by reviewing data on 10, 627 patients (55-76 years old) who underwent a form of stress testing known as stress myocardial perfusion single photon emission computed tomography (SPECT). The test determines the body's ability to deliver blood and oxygen to the heart at rest and under stress. None of the patients had a history of heart attack.

During follow-up, 146 cardiac-related deaths occurred. Analysis showed that in patients with more than 10% of their heart affected by ischemia, there was a lower mortality rate with revascularization than with medical therapy. However, patients with little or no blood flow restriction fared best on medical therapy.

"The greater the degree of ischemia, the greater the risk of cardiac death and also the greater the benefit of revascularization,” said lead author Rory Hachamovitch, M.D., of Cedars-Sinai Medical Center in Los Angeles (CA, USA). "On the other hand, patients with no ischemia had lower mortality rates with medical therapy than with revascularization.” The researchers said this is the first time they have been able to show that SPECT is potentially of even great value in predicting which patients will benefit from a particular therapy.




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