Dr. Manoj J Pradhan, is the leading name in Cardio Thoracic surgery in Pune. He is attached to several reputed cardiac institutes in Pune. He is a visiting surgeon to the leading hospitals in Maharashtra. He has an experience of over 22 years in Cardio Thoracic surgery...

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Treatment options in Coronary Artery Disease

Before undergoing 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:
    • 28% more likely to suffer from a major adverse cardiovascular event, such as stroke or heart attack
    • 46% more likely to require an additional procedure
    • 22% more likely to die

 
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