WASHINGTON (Bloomberg) — Clearing heart arteries from the inside works about as well as open-heart bypass surgery and costs less, a US government study found.In a study of more than 400 heart-attack victims by the Department of Veterans Affairs, survival rates were equivalent for the two types of surgery. The cost of clearing blocked arteries using a catheter inside the blood vessels, known as angioplasty, and treating a patient for five years was 19 percent lower than for open-heart procedures, researchers found.

The findings may add to a debate about whether people with clogged arteries should be treated using angioplasty or the more invasive bypass surgery.

Already, angioplasty is performed four times as often as open-heart operations. Another analysis this year found that bypasses, which require weeks for recovery, may better prevent future complications.

“If all things were equal, you’d go for angioplasty,” said Robert Guyton, chief of cardiothoracic surgery at Atlanta’s Emory University School of Medicine in Atlanta.

“If you are told more about your chances with angioplasty compared to surgery, then you start to think twice.”

Guyton, who spoke in a telephone interview yesterday, wasn’t involved in the VA study, which found a cost benefit for angioplasty. The American Heart Association’s journal Circulation will publish the work in its September 19 issue.

The lead author of the study, Kevin Stroupe of the Edward Hines Jr. VA Hospital in Hines, Illinois, couldn’t be reached for comment.

The majority of angioplasty and bypass patients in the study survived at least five years, and the treatments were considered roughly equivalent in preventing death, the researchers found.

The average cost for treatment and five years of subsequent medical care was $81,790 for cases of angioplasty. For bypass patients, the average was $100,522.

About 1.2 million angioplasties were done in the US in 2002 and 306,000 bypass operations, the researchers said.

In angioplasty, a balloon-tipped catheter is snaked up to the heart through blood vessels through an incision in the thigh. The balloon is inflated where the artery is blocked, making a wider opening. Mesh tubes, known as stents, often are put in place to keep blood flowing in the artery.

In bypass surgery, the rib cage is spread apart to expose the heart. A machine takes over the work of circulating blood to the body during surgery. Doctors take a section of healthy blood vessel, often from a patient’s leg, and attach it above and below the clogged artery, creating a bypass for blood.

The patients in the VA study were randomly assigned to angioplasty or bypass. At least 30 percent of those in both groups had diabetes, and almost half were older than 70, the study said.

The National Institutes of Health and the VA provided funds for the research.