An unexpected variable can affect which of two heart procedures patients are given to treat blocked blood vessels in the heart: geography. It may seem odd, but where people live can greatly influence whether they receive coronary bypass surgery or instead undergo a procedure known as angioplasty, which often involves implanting a stent. Both procedures aim to increase blood flow to the heart, but they are not interchangeable. Coronary bypass surgery is far more invasive and carries greater risks than angioplasty, in which doctors thread a catheter tipped with a tiny balloon into a narrowed vessel and, in many cases, use a stent on the end of the catheter to prop open a narrow blood vessel.
Angioplasty is also not without risk. Relative to bypass surgery, it's more likely to require follow-up procedures. Some experts argue that patients who are considering either procedure should first understand all the risks and benefits of both; too many patients get only limited information about one procedure or the other. (For some people, there are also alternatives—including optimizing medication and lifestyle changes.) Read U.S. News' s story Heart Health: Coronary Bypass Surgery or Angioplasty? to help you decide which may be right for you.
As that article notes, researchers at the Dartmouth Institute for Health Policy and Clinical Practice have long observed very different practice patterns across the United States, not only for heart procedures but for everything from hip replacements to intensive care usage. The most recent information from the Dartmouth Atlas database (based on 2005 Medicare data) shows that for every coronary bypass surgery performed in the United States, there are about 2.6 angioplasty or stent procedures performed. Take a closer look at certain communities, and the ratio increases considerably. The data don't reveal what the "correct" rate of these heart procedures should be, says Elliot Fisher, the Dartmouth Atlas's principal investigator and a professor at Dartmouth Medical School.
Below is a list of the 10 U.S. cities where heart patients are most likely to get an angioplasty/stent procedure rather than coronary bypass surgery (ratio between the two alternatives shown; national average ratio is 2.6). Separately, we've listed 10 places where bypass surgery outpaces angioplasty.
|1. Davenport, Iowa||13.80|
|2. Burlington, Iowa||11.27|
|3. Elyria, Ohio||9.40|
|4. Fremont, Calif.||9.28|
|5. Clinton, Iowa||8.54|
|6. Lorain, Ohio||7.65|
|7. Missoula, Mont.||6.70|
|8. Houma, La.||6.59|
|9. Bronxville, N.Y.||6.56|
|10. Norwalk, Ohio||6.31|
Source: Dartmouth Atlas Project
Related: Top 10 Cities Where Coronary Bypass Surgery Outpaces Angioplasty