Which Non-Medicinal Treatment for Severe Coronary Artery Disease?

Coronary atherosclerosis involving more than one coronary artery can progress to a heart attack at any time, and calls out for treatment. Should the patient have a coronary artery bypass graft (CABG) or a percutaneous coronary intervention (PCI)? CABG involves opening the chest and re-routing the blood flow through a new vessel that is grafted around diseased sections of your coronary arteries. PCI (formerly called angioplasty) is done by inserting a catheter into a vein in the groin or arm and passing it up to the heart; atherosclerotic plaques in the coronary artery walls may be cleared by inflating a baloon, and the artery can be held open by inserting a stent.

Treatment with CABG or PCI provides similar long-term mortality rates in coronary disease, and there has been considerable research done to see which procedure is best. A study reported in the Lancet describes results from 10 randomized trials comprising nearly 8,000 patients with multi-vessel coronary disease. The purpose was to investigate whether patient characteristics affected long-term mortality rates after CABG or PCI.

The numbers of deaths or heart attacks (myocardial infarctions, or MIs) were similar in the two treatment groups. However, patients with diabetes and those aged 65 and older had a significant survival advantage with CABG. Finally (maybe!) the dilemma is resolved. There’s no obvious difference between CABG and PCI for most people, but not for those over 65 or who are diabetic. Of course, ‘older’ patients (i.e. those over 65) may prefer the less invasive approach even if the mortality risk is higher, but their choice must be based on full information of the pros and cons of each type.