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Which coronary artery disease treatment is better?

Determining optimal treatment for coronary artery disease is complicated by evolving technology, differing result interpretations, and variable study designs. While survival is an important consideration, other nonfatal outcomes should be also be considered. A heart team that includes a cardiac surgeon, cardiologist and the patient is essential to determine the best treatment.

Mandy Higuera
Cardiologist (Heart Specialist)

That's an easy question with a rather vague answer—"it depends." We all have different values and beliefs as they pertain to our health and how we manage our health. How you perceive your health state, your lifestyle, your beliefs about western medicine or other integrative therapies, maybe even your culture or religious background can affect what treatment(s) are best for you. Age also plays a big part in decisions like this, as does your view of your current health state. (You may feel great and decide there is nothing that needs to be done right now.) In any case, its best to have a thorough and thoughtful discussion with your primary care provider—and explore from there! It is important to keep your primary provider in the loop though, because they are a partner in your care. There is no "this is better than that" if we take the science away from the question, because at the end of the day its what you the individual believes is best for you—based on exploring all your options.

Many people with coronary artery disease want to know if they need an operation. We spend a fair amount of time explaining why we're recommending surgery. I always sit down with people and talk to them about the alternatives for coronary artery disease. The majority of the people that we see opt for coronary bypass surgery. They can have medical treatment such as angioplasty or stent implants, which are done by cardiologists, or they can have bypass surgery.

Depending on what the findings are at the catheterization, we'll sit down and explain to them why we think one is the preferred method. The person always has the right to make a decision and to say yes or no to surgery.

Once we get over the first step of making sure that they need surgery and that they understand the reason for it, probably the next questions are, "Is it going to hurt? What kind of incision are you going to make?"

Most people don't have severe pain with heart surgery. They're obviously asleep during the operation, but we're good these days about keeping people comfortable. The incision that we use for most people with heart disease is a standard sternotomy incision, up and down the middle part of the chest, but for special situations, we use smaller, more minimally invasive or lesser incisions. It depends on what operation they need and what the safest and best way to do the procedure is.

When heart artery blockages pose a serious health risk and medications are not successfully eliminating symptoms such as shortness of breath or chest pain, there are two treatment options: either through the interventional procedures of angioplasty and stenting or through coronary artery bypass graft surgery.

In angioplasty and stenting, an interventional cardiologist inserts a thin tube called a catheter into the patient’s artery and threads it to the site of the blockage. The interventional cardiologist then opens and closes a small balloon at the tip of the catheter to push aside the blockage. Then a metal mesh tube called a stent is delivered to the former blockage site by the catheter and is inserted into the artery to serve as scaffolding to prop it open.

During coronary artery bypass graft surgery, a doctor grafts a vein or an artery from a leg, arm or other part of the body to the coronary artery to enable blood to “bypass” a blockage and continue on to the heart.

The type of treatment that is best for a patient depends on that individual and the individual’s anatomy. So if someone, generally speaking, has one or two blockages, and if the interventional cardiologist finds the blockages suitable for stenting, then angioplasty and stenting may be the best procedure. When a patient has many blockages in an artery or many arteries that are completely blocked, then stenting may not be in the best interest of the patient. In that case, the patient would be referred to a cardiovascular surgeon for bypass surgery.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.