Desisions of the Heart
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Treatment Options: Medicine, Stenting or Bypass Surgery?

Treatment OptionsBefore receiving an angiogram, it's important to understand your treatment options. If your angiogram shows blockage, then a treatment decision must be made quickly. To ensure you are receiving the right treatment, it is essential that a comprehensive heart team consisting of a cardiologist, interventional cardiologist and cardiac surgeon review your case together prior to making a treatment recommendation for your CAD.

The three mainstays for treating CAD are medicine, percutaneous coronary intervention (PCI) with the placement of one or more stents, and coronary artery bypass graft (CABG) surgery.

The three potential reasons to take medicine or undergo CABG or PCI are:1

  • reverse ischemia and alleviate symptoms of CAD
  • reduce the risk of death in the future
  • treat or prevent CAD-related complications such as heart attack, irregular heartbeats (arrhythmias), or heart failure

There has been ongoing debate about the best treatment option for patients with CAD. However, new data that was recently presented at a major cardiovascular conference provides important clarity around how to determine which patients are best served by what procedure. The study results showed that:

  • Hundreds of thousands of patients with moderate “not just severe“ CAD could have been better treated with bypass surgery versus receiving a stent
  • After three years, data show that patients who received a stent versus undergoing bypass surgery were:

These data demonstrate that less invasive procedures, such as medicine or PCI, which are attractive to patients, may work well with less severe CAD that affects only one vessel or the branches of the right coronary artery. However, patients with moderate or severe CAD who have blockages in two or more arteries, a blockage in the left main coronary artery, or risk factors such as diabetes, have better survival rates and better reversal of ischemia with CABG surgery. 24

Making your Decision of the Heart

The American College of Cardiology (ACC) and the American Heart Association (AHA) develop and periodically revise guidelines based on the latest and most comprehensive clinical studies of CABG and PCI in CAD patients. These "evidence-based" guidelines describe for physicians under what specific conditions CABG or PCI should be performed.

According to the ACC/AHA guidelines, the decision to treat with CABG or PCI should be made objectively based on the following:

  • Medicine or PCI can treat patients with chronic stable (predictable) angina who have one-vessel or two-vessel CAD and no significant plaque in the left main or left anterior descending artery.
  • CABG or PCI with stent placement may provide similar initial results in people with simple cases of "multi-vessel disease," but not if the left main artery is affected by CAD.
  • CABG provides best results for patients whose left main artery is blocked or those with multi-vessel disease that includes the left main artery.
  • CABG surgery is recommended for patients who have diabetes, are of advanced age or have a condition where the function of the left ventricle of the heart is impaired.

The evidence-based guidelines consider factors such as type of angina, level of ischemia, ventricular function, number of coronary vessels diseased, and various other factors.4 To ensure you're receiving the right treatment, it's essential that a multidisciplinary heart team consisting of a cardiologist, interventional cardiologist and cardiac surgeon review your case together prior to making a treatment recommendation for you.