Bypass beats angioplasty for quality of life, costs

Functional status is improved more with bypass surgery than angioplasty in patients with multivessel coronary disease in the first three years after the procedure, according to Bypass Angioplasty Revascularization Investigation (BARI) researchers.

The researchers in the multicenter BARI trail compared quality of life, costs, and employment status after revascularization in 934 patients. They found that in patients with three-vessel disease, quality of life was better for the first three years following coronary artery bypass graft surgery (CABG) compared with the first three years following angioplasty. However, angioplasty patients returned to work five weeks sooner than CABG patients.

They also found that the lower cost associated with angioplasty exists only for patients with single- or two-vessel disease. The initial cost of angioplasty was a little more than $21,000, which is 65% of the $32,000 cost associated with CABG. However, after five years, costs associated with angioplasty were nearly the same as costs associated with bypass surgery because of the higher subsequent need for hospitalization and medications in angioplasty patients. (N Engl J Med 1997; 336:92-99.)