Stenting (PCI) vs Surgery (CABG) for Coronary Artery Disease

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There are various modalities of treatment for CAD. The best form of treatment is dependent on variables like –the number of stenoses (blocks),the nature and location of the stenoses in the coronary arteries, the presence of diabetes mellitus and various other patient related factors.

For those who have multivessel or left main coronary artery disease, surgery, not percutaneous intervention (PCI) or stents, offers the best long-range outcome, according to David Taggart, MD, Professor of Cardiovascular Surgery at England’s University of Oxford – http://www.sts.org/node/2261

The treatment of coronary artery disease in the West has moved onto a multidisciplinary approach with the two treatment options being discussed by the cardiac surgeon and the cardiologist before offering the best possible therapy to the patient.

CABG is a safe procedure when performed by those with appropriate expertise and has good long term prognosis.

Dr. Taggert also mentions “Failure to discuss CABG (coronary artery bypass grafting) means that the patient is often denied the best treatment option. Consent for PCI is often obtained inappropriately. Doctors are obligated to explain alternate options if they are more effective. Usually, the cardiologist is the gatekeeper, and there is a conflict of self-interest there, it is a self-referral. All patients with multivessel disease should be treated by a multidisciplinary team, including a surgeon.” – http://www.sts.org/node/2261

Studies have also shed light on the merits of CABG over PCI under appropriate conditions. For example, a study published 2005 in the New England Journal of Medicine concluded that for patients with two or more diseased coronary arteries, CABG is associated with higher adjusted rates of long-term survival than stenting. That study showed that patients with three blocked arties who received stents were 56 percent more likely to die within three years as those who had bypass surgery. That study was addressed in a Wall Street Journal article which said that stenting, the popular, minimally invasive angioplasty procedure, carries a higher risk of death long term than does open heart bypass surgery as a treatment for blocked arteries. The Journal reported that more than a third of patients who received stents needed either surgery or additional angioplasties with stents within three years. – http://www.sts.org/node/2261

If you or a family member is diagnosed to have coronary artery disease it would be prudent to have a discussion with both your cardiac surgeon and cardiologist prior to treatment.