Both therapies were developed to treat coronary artery disease (CAD), or hardening of the arteries. CAD occurs when plaque deposits build up inside the coronary arteries, which supply the heart with blood, and may result in a heart attack.

Although both therapies are effective, each has relative strengths and weaknesses. Studies have shown that patients who undergo bypass surgery tend to have slightly better results than patients who undergo angioplasty. However, bypass surgery requires several months of recovery and is major open-heart surgery. Bypass surgery involves splitting the chest and sewing vessel grafts onto the patient's coronary arteries to bypass any blockages.

By contrast, patients who undergo angioplasty can fully recover in a just a few weeks. The major downside to angioplasty is the risk of restenosis, which occurs when the recently opened coronary arteries close again after the procedure is over. Stents, which are small wire-mesh tubes, have reduced the rate of restenosis, but it still occurs in up to 20 percent of cases and may require additional angioplasty or bypass surgery. Angioplasty is a catheter-based therapy in which a physician threads a long, thin tube through a patient's arteries, into the coronary arteries, then rapidly inflates a balloon. This crushes the plaque against the arterial wall.

The new scale, developed by researchers at the Mid- America Heart Institute in Kansas City, Mo., ranks patients by their expected chances of restenosis. Patients at intermediate or high risk of restenosis are referred for bypass surgery.

The scale takes into account several factors, including the presence of diabetes, a heart attack in the past 24 hours, an acute heart attack, chest pain, previous angioplasties, and multi-vessel disease. It was published in the most recent issue of Circulation.

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