Choosing the best procedure

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Submitted by Dr T on January 18, 2015 – 4:15pm

Question: 
I proactively requested a stress test, at 66, due to not having had one in 10 years and my sister just had emergency CABG, possibly with genetic factors causing the coronary artery disease. Stress test completed, problem found, angiogram done 2 days ago.  Two blockages, 90%-95% occlusion of LAD near bifurcation; 75% occlusion of an artery on right side (don’t remember name).Dr. did not put in stents, wanting me to have choice of stents or CABG.  Told son ‘I have enough of a landing-zone to successfully put in stent’.  Will not make a recommendation, except to say CABG gives the better long term result.No other known health issues except hypertension treated for 5 years with Benazapril 40mg.  Lost 20 lbs in 2014, need to lose 20 more.  Rather sedentary lifestyle.. but will change that, of course.After talking to cardiologist and surgeon, I am more confused than ever.  I don’t know which procedure to choose??  Risk factors do not seem to be much different, based on 5 year numbers in the studies discussed by cardiologist and son (biologist/scientist, PhD).I don’t know what to do!  Last night I had the first angina episode…. took nitro tablet and it pasded, but I was just talking with family, not exerting myself, so I think this means ‘unstable angina’ now… 

Stents have a 10-15% failure rate in the first year of implant when the cardiologist judge it is an optimal situation. In your case, if a procedure is indicated, you will be much better of with a CABG. I have written about your situation here: How long does a heart stent last? Do they need to be replaced?

Contrary to what you heard,  there are significant differences between stents (PCI) and CABG. Here is a review I wrote for medical professionals: CABG Superior to PCI in long-term treatment of coronary artery disease

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Hope this helps,

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