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Is CABG or angioplasty better for young people with heart disease?

Coronary artery bypass grafting (CABG) may be better than angioplasty for young people with heart disease. A study showed that young people with severe coronary artery disease may experience better long-term outcomes when they are treated with CABG instead of more popular and less invasive angioplasty and stent, also known as percutaneous coronary intervention (PCI).

An increasing number of young people with coronary artery disease are being offered stents primarily, but the study showed that they may be better off with CABG. The researchers examined data from 100 people who received stents (PCI or angioplasty) and 100 people who underwent CABG. All the people were younger than age 50. The operations were performed between January 2004 and December 2004, and then followed at intervals of 5 and 12 years. Follow-up information was collected from clinical notes and telephone surveys with the people or their general practitioners in December 2009 and again in December 2016.

The researchers compared the two groups, looking closely at the rates of myocardial infarction (MI, or heart attack), repeat revascularization, and total major adverse cardiovascular and cerebrovascular events (MACCE). At the five-year follow-up, all of these rates were significantly greater in the PCI group compared to the CABG group: MI was 9 percent vs. 1 percent, respectively; repeat revascularization was 31 percent vs. 7 percent, respectively; and MACCE was 34 vs. 13, respectively. Similarly, at the 12-year follow-up, the rates of the PCI group were considerably higher than those of the CABG group.

The extent and severity of coronary artery disease was important in the study. When researchers examined data from people with one- or two-vessel coronary artery disease, they found no differences in the rates of death, MI, stroke, repeat revascularization or MACCE. However, in those who had more extensive, three-vessel disease, these rates were significantly higher in the PCI group compared to the CABG: MI was 47.6 percent vs. 19.2 percent, respectively; repeat revascularization was 66.7 percent vs. 20.5 percent, respectively; and MACCE was 19 in 21 people vs. 31 in 78 people, respectively.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.