There are two mechanical ways to treat coronary artery blockages. Blockage in the heart arteries can be treated with surgery (Coronary Artery Bypass Graft) or with balloon angioplasty/stent (Percutaneous Coronary Internvetion [PCI]).
How can the doctor and patient decide together whether or not to have one (or sometimes both) of these procedures.
Well, the American Heart Association and the cardiologists and heart surgeons have developed outstanding guidelines. There are three resources for decision-making for doctors and patients.
The first is the 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery.
The second is the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention.
The third resource is the one that I think most physicians and patients will find most useful. And that is the 2011 ACCF/AHA Pocket Guideline: Management of Patients Undergoing Coronary Artery Revascularization.
So there are two reasons to treat coronary artery blockages. The first is to help the patient live longer. If the number of blockages (cholesterol buildup) and the positions of the blockages are bad enough, a person stable ischemic heart disease (SIHD) can be at increased risk of death. In that case, there is good evidence that coronary artery bypass graft surgery help a person live longer.
There is also hope that PCI (angioplasty/stent) procedures in patients with very severe coronary artery disease will increase survival.
However, the Pocket Guideline states that “No study to date has demonstrated that PCI improves survival rates in patients with SIHD (Stable Ischemic Heart Disease).” SIHD means the person gets agina reproducibly but is not having any signs of an acute heart attack or unstable angina.
For persons who are having a heart attack or unstable angina there is strong evidence that emergency PCI is very necessary.
The second reason to treat coronary artery blockages in patients with SIHD is to improve the symptom of angina.
For complete information on the diagnosis and treatment of Stable Ischemic Heart Disease see the ACCF/AHA 2012 Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease*.
Each of the three guidelines has excellent information on when to consider CABG and/or PCI to treat angina symptoms.
Again, the Pocket Guide is the one that I think is most user friendly for doctors and patients.
Additional Resources:
*2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease(PDF) (HDML), Circulation. 2012;126:e354-e471; originally published online November 19, 2012.
