
MASSDEVICE ON CALL — Heart bypass surgeries in decline. Coronary artery bypass graft surgeries (CABG) are dropping in popularity, especially compared to other cardiac revascularization procedures, a new study shows.
The annual rate of CABG surgeries performed in the United States dropped 38 percent between 2001 and 2008, according to research published in the May 4 issue of Journal of the American Medical Association.
Authors of the study wrote that the findings imply "a sizable shift in cardiovascular clinical practice patterns away from surgical treatment toward percutaneous, catheter-based interventions."
The overall rate of coronary revascularizations — CABG surgeries and in-and-out catheter-based procedures like angioplasties and stent insertions — fell from just under 1,500 per million adults a quarter in 2001 to less than 1,250 per million adults a quarter in 2008, according to the study.
The most intriguing finding in the data was that virtually all of the decline was in the most serious cases — those requiring CABG, which fell by about a third. The rate of percutaneous coronary interventions (or PCI, where they snake a catheter through the thigh into the blood vessels feeding the heart, propping them open with either drug-eluting or bare metal stents) remained virtually unchanged, writes health care journalist Merril Goozner.
Dr. Peter Groeneveld, the study’s corresponding author and assistant professor at University of Pennsylvania School of Medicine said the data imply a "sizeable shift" in cardiovascular clinical practice away from surgical treatment toward PCI in prepared remarks.
"The ratio of PCI to CABG used to be 2 to 1 and now it’s 3 to 1," Groeneveld told heartwire. "That’s a bit of a concern, because we know from the SYNTAX trial that CABG is the better alternative for patients with triple-vessel and left main disease."
But interventional cardiologist Dr. Jeffrey Moses of Columbia University calls this interpretation of the SYNTAX trial "astonishing" and "disingenuous."
"I don’t think these guys have been going to the same meetings that I have!" he told the publication.
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