Dr. Hannan studied the outcomes of more than 17,400 procedures for people with multiple blocked coronary arteries.
The outcomes were consistently better in an 18-month follow-up for bypass surgery than for the artery-opening procedure called angioplasty followed by insertion of a drug-coated tube known as a stent.
For example, 92.1 percent of those who had surgery for three blocked arteries had no heart attacks and were alive, compared to 89.7 percent of those who got stents.
For those with two blocked arteries, the comparable numbers were 94.5 percent for surgery and 92.5 for stent implants.
The study was not a randomized, controlled trial, which is regarded as the gold standard for medical research.
It was observational, meaning that the researchers simply recorded what happened in medical practice rather than trying to control all the factors involved in choosing a treatment.
But the randomized trials done in the past have not necessarily been better, explains Dr. Hannan. They were restricted to patients who were not very sick, and they also did not recognize that when you compare two treatments, some patients might not prefer the one that is more invasive.
Surgery is more invasive than angioplasty, since it requires the chest to be cut open. Angioplasty is done by threading a flexible tube called a catheter through a blood vessel into the heart.
One shortcoming of the study is the relatively short follow-up period of 18 months, says Dr. Joseph P. Carrozza, at Harvard Medical School, who wrote an accompanying editorial.
One would like to see patients followed for up to five years, says Dr. Carrozza.
There is nothing in this study that makes us feel surgery is the treatment of choice for patients with multi-vessel disease, he adds.
Such a verdict will have to wait on the results of several randomized trials now underway, says Dr. Carrozza.
This is just one piece of evidence we have right now before we get the final word, he explains.
And yet, Dr. Carrozza says, This is the first really large study to look at this issue now and thus should be considered by physicians and heart patients requiring treatment for blocked coronary arteries.

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