Narrowing of the blood vessels of the heart (coronary arteries) is mostly due to blockages and can lead to issues like heart attack or heart failure. This narrowing is referred to as Coronary Artery Disease (CAD) and is responsible for most lives lost across the globe. While prevention is always better than cure, here we briefly touch upon treatment options, with particular emphasis on angioplasty vs bypass surgery.
Management options for CAD are few: 1. Do nothing: Bad option. Heart diseases are the most common reasons for death and disability around the world, including India. One should actively try to reduce its ill effects. 2. Medications alone: Medications are indicated for all patients who are diagnosed to have blockages. Many times, medications alone are enough for effective treatment. 3. Medications + stents: When medications fail or have a high likelihood to fail (based on the individual clinical situation), stents can be placed to open individual blockages. 4. Medications + bypass (CABG): Coronary Artery Bypass Grafting is a surgical procedure where channels are created bypassing the site of blockages. CABG is done when medications have failed (or high likelihood to fail) and stents are not suitable.
The description below is generic in nature, and may not apply to individual cases. Please refer to your doctor for individualized case discussion and planning.
The general approach in managing coronary blockages: 1. All patients with diagnosed or suspected of CAD should be started on evidence-based medicine regardless of whether angioplasty or CABG is chosen. 2. All patients with acute heart attack (particularly ST elevation type) should undergo urgent angioplasty. 3. Patients with non-critical blockages, at non-critical locations, are typically tried on medical therapy first before given a choice between angioplasty or CABG. There are exceptions to this situation and the clinical decision should be individualized. 4. Patients with critical blockage at the critical location should be offered angioplasty. 5. Patients with too many critical blockages (typically more than 2), or blockages at areas which are high risk for angioplasty, should go for CABG.
Most of the time, the decision of angioplasty vs CABG is straightforward for doctors. Simple 1-2 blockages can be easily handled by angioplasty, vs multiple/complex blockages go for CABG. Occasionally though, blockages may seem suitable for either angioplasty or CABG. In such cases, a frank discussion between treating doctor and patient/family should take place. Below are a few additional aspects to consider:
1. CABG is a major surgical procedure, vs angioplasty is minimally invasive. 2. Short-term risk is less with angioplasty. 3. CABG requires about 6 weeks of rehabilitation, vs angioplasty for about one week. 4. Although medicines should be continued in both, angioplasty demands a higher disciplined medication management. 5. Future need for repeat angiography/angioplasty is higher with angioplasty than with CABG. 6. Patients with Diabetes and multiple blockages do better with CABG compared to angioplasty.
Other factors to be considered before making a decision includes heart pumping function, any associated valve related issues, lung capacity, age and physical fitness, any other major organ dysfunction, cost of the procedure etc.
As you can see, a decision between angioplasty and CABG is based on multiple factors and is highly individualized based on clinical parameters of the index patient. We should refrain from generalizing that one procedure is better than the other as they both have their roles in patient management. Most important is to have a discussion with your treating doctor, understanding the rationale of the decision taken, pros and cons tailored to the individual patient, and finally patient wishes.
I am sure I didn't answer all your questions on this topic. Feel free to message me your queries and I will be happy to answer those.