STUDY PLACES ANGIOPLASTY ON PAR WITH BYPASS : PROCESSES DIFFER LITTLE AFTER 5 YEARS.

Byline: Mike Robinson Associated Press 

Angioplasty offers about the same quality of life and relief from symptoms after five years as heart bypass surgery, according to the biggest comparison of the artery-unclogging procedures.

But the study in last week's Journal of the American Medical Association also noted that angioplasty patients often must undergo the procedure more than once during those five years because the arteries clog back up.

Dr. George Sopko of the National Heart, Lung and Blood Institute in Bethesda, Md., who headed the research, said it shows the two approaches are both very good.

Other doctors were quick to criticize it, however, saying it did not take into account state-of-the-art refinements in treating clogged arteries and did not fully consider the need for repeat angioplasties.

In bypass operations, surgeons cut open the chest and graft new blood vessels to increase blood flow to the heart. In angioplasty, cardiologists thread a balloon into the heart by way of an incision in the thigh to force open clogged blood vessels.

Dr. Timothy Gardner, chief of cardiothoracic surgery at the University of Pennsylvania, said the study underemphasizes the need for repeat angioplasties on some patients. He noted that just 5 percent of bypass patients need another procedure within five years.

``Nobody is getting harmed by having angioplasty first,'' Gardner said. ``But the people who have angioplasty are going to have many more procedures, and at least a third are going to end up having surgery anyway.''

Dr. Sidney Smith, chief of cardiology at the University of North Carolina, said the study may have had different results had it considered new techniques in artery unclogging, such as powerful cholesterol-fighting drugs and the use of stents - expandable metal devices inserted into arteries to prop them open.

The study ``looks at the state of the art in the late '80s, but the state of the art has changed,'' Smith said.

Each year, 550,000 Americans have either angioplasty or bypass surgery. The five-year survival rates for the two procedures are about the same, except for patients with diabetes. They do better with bypass surgery.

The average age of the 1,829 patients studied was 61, and 73 percent were men. In all, 914 underwent bypass surgery and 915 angioplasty.

Patients were evaluated four to 14 weeks afterward, again at six months and then annually for five years. Researchers studied their symptoms, exercise test results, medication and quality-of-life factors centering on jobs, housework, sex, relationships, hobbies, interests and vacations.