Analysis of trials of surgery vs angioplasty in myocardial revascularization

Abstract

Aim: comparison of surgery and angioplasty for the treatment of coronary artery disease.

Method: comparison using randomized trials for low-risk patients and observational studies for high-risk patients.

Results: in low-risk patients, a strategy of initial surgery or angioplasty achieved similar results regarding overall and infarct-free survival rates at 5 years. Residual angina was statistically more prevalent after angioplasty and required more subsequent revascularization procedures. Residual angina negatively impacted on life quality. Angioplasty initially had a cost-effectiveness advantage over surgery, which subsided over time. In high-risk patients, no firm conclusion could be drawn, due to unmatched selection of patients. Angioplasty seems superior in acute myocardial infarction and in very ill patients. Surgery seems superior to treat diseased bypass grafts.

Conclusions: because of similar achievements, the choice of therapy in low-risk patients eventually should depend on patient's preference. During counselling, the deleterious effect of residual angina on life quality and health perception should not be underestimated by practitioners. In high-risk patients, further studies are required to define the best approach to any individual patient.