: Surgery or angioplasty after angiography? After angiography (done for episodes of anginal chest pains), how do doctors decide whether to go for angioplasty (balloon dilatation of blockages of arteries of heart) or surgery

Vote Up Vote Down   0 Reactions

Login to give Reaction!

Patients with following features on angiogram have better results with coronary bypass surgery (CABG) than after angioplasty (percutaneous coronary intervetion, including balloon dilatation, stenting etc):

Left main coronary disease
Multi-vessel disease in patients with diabetes mellitus
Triple-vessel disease with left ventricular dysfunction
Double vessel disease, including proximal left anterior descending artery involvement, and left ventricular dysfunction
Calcified vessels
Diffusely diseased vessels
Highly tortuous vessels
Ostial lesions
Bifurcation lesions

These features indicate that angioplasty may be associated with greater likelihood of suboptimal immediate result and/or greater risk of complications later on (such as restenosis or the dreaded subacute thrombosis in the treated artery). Hence, bypass surgery is generally advisable in these cases.

References:
circ.ahajournals.org/content/126/25/e354.full sign.ac.uk/guidelines/fulltext/96/index.html eurheartj.oxfordjournals.org/content/early/2013/08/28/eurheartj.eht296 www.nice.org.uk/guidance/cg126

Vote Up Vote Down   0 Reactions

Login to give Reaction!

There have MANY trials comparing PCI (intervention during the "cardiac cath" procedure) which are well referenced in this guideline update. (Note, the "Heart Team" approach mentioned below relies on the combination of the expert opinion of the interventional cardiologist was well as the cardiac surgeon.)