Choosing Angioplasty (PTCA) or Coronary Artery Bypass Surgery (CABG)
People whose angina has not been relieved by medications are candidates for PTCA. The ideal candidate has only one narrowed artery, although many persons with several areas of narrowing can undergo PTCA.
The decision to recommend PTCA rather than bypass surgery is based on the location, number and severity of blockages, as well as the overall function of the heart. However, the procedure does not cure the underlying disease. In fact, the procedure may have to be repeated to reopen the same or another artery that becomes blocked. Compared to CABG, PTCA generally costs less and involves a shorter period of hospitalization.
If you have mild angina or recovered from a heart attack with no continuing symptoms, you are probably best treated by medication or other means, rather than by a bypass or another operation. Your doctor may recommend CABG in appropriate situations, such as:
- a blocked left main coronary artery
- disease in multiple vessels and poor function of the left ventricle (the main pump of the heart)
- debilitating angina - For these persons, a bypass procedure is of clear value in most cases and life is clearly prolonged.
Several randomized trials have shown that during follow-up periods of several years, the infarction (heart attack) and mortality rates of CABG and PTCA are comparable. An exception may be patients with diabetes who have better outcomes with CABG than PTCA.
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