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Success of bypass surgery questioned.

Success of bypass surgery questioned

Although coronary bypass surgery is beneficial in the short term, its advantage to heart patients gradually decreases, according to new statistics from the European Coronary Surgery Study Group. Seven years ago, the same group reported that during the first five years after surgery, bypass patients had a significantly higher survival rate than those who received only medical treatments determined by their physicians.

But after continuing to follow survivors among the 767 men (all of whom were under age 65 when the study began, and none of whom initially had severe symptoms), the researchers found the percentage of surgical patients who survived decreased in the seven years following their first report. During these seven years, the researchers report in the Aug. 11 NEW ENGLAND JOURNAL OF MEDICINE, "the patients originally assigned to surgical treatment who survived to five years fared worse than those [who survived to five years] in the medically treated group, and the benefit of early surgical treatment gradually decreased."

Overall, the scientists say, there is still a slightly higher rate of survival among patients treated with surgery.

The European study is one of three large, randomized studies comparing the usefulness of two treatments for chest pain, or angina, when the need for surgery is unclear. In 1984, the Veterans Administration Coronary Artery Bypass Surgery Cooperative Study Group reached similar conclusions from an 11-year study. And in 1983, researchers conducting the Coronary Artery Surgery Study found little difference between medical and surgical treatment after following some patients for as long as seven years (SN: 11/5/83, p. 294).

Although the European researchers do not offer an explanation for the findings, some physicians suggest that using a vein in the leg, once the most common procedure for coronary bypass, does not provide long-term benefit. "There's quite a bit of evidence that disease develops in the grafts and they don't stay open," says Katherine Detre of the Veterans Administration Medical Center in West Haven, Conn., who coordinted the 1984 study. Detre says researchers are now finding the internal mammary artery a more successful bypass.
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Author:Beil, Laura
Publication:Science News
Date:Aug 13, 1988
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