When deciding between medical therapy, heart stents (angioplasty) or cardiac bypass surgery, I take into account the full picture based on factors such as:
- Clinical presentation
- Patients age
- Mental and neurologic status
- Location and severity of the blockages
- Symptoms
- Ability to take long-term blood thinning tablets and
- Other issues such as diabetes, kidney function and heart failure along with patient expectations and preferences.
I also use validated specific “scores” to help decide the strategy such as “Syntax” score. These scores however, have to be interpreted in context to be meaningful and useful.
When the issue falls in the grey zone however, a Heart team comprising of the patient, interventional cardiologist, cardiac surgeon and often the general or family physician can help arrive at a suitable decision.
Coronary angioplasty (heart stent) in general leads to quicker recovery as there is no open-heart surgery involved and procedure is shorter. There are certain limitations such as possibility of disease progression inside or around the stent (uncommon with current drug-eluting stents and good technique during angioplasty) and the need to continue blood thinning medication for a longer period.
Cardiac bypass surgery can give long-term benefit when the narrowing is severe and extensive (ie throughout the blood vessel) with diabetes and poor heart function though this has to be considered in context (ie someone with general high risk for surgery such as the very elderly or with a previous stroke) may still be better off with angioplasty.
In many cases, however the angiogram helps in easy decision making and is quite straightforward and an open, transparent discussion helps in decision-making.
