A new study has revealed how short term and five-year mortality are varied for two different treatments for coronary artery disease. The national study was funded by the British Heart Foundation and published in the European Heart Journal Open.
The researchers at the University of Leicester looked at 173,771 people undergoing Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Grafting (CABG) in England between 2009 and 2015.
The study found the preference for PCI or CABG to treat patients with severe coronary artery disease varied greatly across regions of England.
It also showed that regions with a preference for less invasive PCI, experienced fewer in-hospital deaths, but significantly more deaths overall within five years. The analysis suggests that for patients suitable for either treatment, prioritizing surgery could have potentially prevented nearly 3,000 deaths during the study period.
Discuss with your doctor
Professor Bryan Williams, our Chief Scientific and Medical Officer, said:
"This study adds good quality evidence to the ongoing debate over the merits of these two interventions for patients with coronary artery disease, either PCI or heart surgery. In particular, the proof of differences between short-term and long-term outcomes will help discussions over what standard practice should be.
"It is important to remember that these two treatments are often better suited to different groups of patients. Patients considered high risk for surgery are more often selected for PCI. Whilst this study made efforts to account for this, it could partly explain why the longer-term outcomes for PCI were worse. If you are undergoing treatment for coronary artery disease, it is best to discuss with your cardiologist which treatment would be best for you."
CABG improves blood flow to the heart by surgically creating a bypass or detour around the blocked arteries, typically using a blood vessel from another part of the body.
PCI is a non-surgical catheter-based procedure which uses a small balloon to inflate the narrowed artery (angioplasty) before placing a stent to improve blood flow to the heart. PCI is considered less invasive, but the long-term durability of surgery may offer a survival advantage for certain complex patients.
Mortality as a measure
The researchers say that the use of in-hospital mortality rates as a quality measure could be driving the choice of treatment, rather than using long-term survival rates.
Professor Gavin Murphy, British Heart Foundation Chair of Cardiac Surgery at the University of Leicester, and lead author of the study, said:
“These results question the value of hospital mortality as an indicator of the quality of care for people requiring heart treatments.
“The Secretary of State for Health claimed in 2013 that the publication of hospital mortality rates following heart surgery would reduce deaths. Instead, this appears to have pushed people towards less invasive PCI treatments that have low in hospital mortality but do not have the same long-term benefits as surgery.”
Find out more about our research here
