Weighing surgery vs. angioplasty.

A 1996 study of 934 patients may offer some guidance to heart disease sufferers, their doctors and insurance companies facing a choice between open heart surgery and the less-invasive procedure called balloon angioplasty. Unlike earlier studies, which just measured the initial cost and short-term results of the two procedures, the latest one followed patients for five years.

"What we are talking about are two significantly different methods of correcting heart disease: a major surgical procedure that involves breaking chest bones, [compared] with a much simpler procedure that, under local anesthetic, involves inflating a balloon to reduce or eliminate blockage by widening the area of blood flow," explains Mark a. Hlatky, professor of health research and policy, Stanford (Calif.) University School of Medicine, the study's lead author. The difference between the two methods, he says, is roughly comparable to the difference between unclogging a sink by pouring a chemical down the drain vs. opening and replacing worn and clogged pipe joints leading to the sink.

"I would now tend to recommend bypass surgery for patients with three blocked vessels and angioplasty for patients with one blocked vessels. They're both good procedures in the hands of experienced doctors. In patients with two blocked vessels who can be treated with either angioplasty or surgery, the medical results are so close that how the patient feels about the two options should be given the most weight in the decision."

Yet, there are differences that may affect patients individually, he points out. "The chance of complete angina [chest pain from heart disease] relief and improvement in physical capacity is somewhat better with bypass surgery, but at the price of more initial discomfort, a longer hospital stay, and longer recovery time.

"Angioplasty is much easier initially, but half the patients will eventually need a second...