Every year in Australia, tens of thousands of people undergo procedures to restore blood flow to the heart.
According to the Australian Institute of Health and Welfare (AIHW), in 2021-22 more than 43,700 percutaneous coronary interventions (PCI) and around 12,700 coronary artery bypass graft (CABG) surgeries were performed in Australian hospitals which are two of the most common treatments used to restore blood flow.
For many patients diagnosed with coronary artery disease, the question that follows an angiogram is often:
“Will I need a stent, or bypass surgery?”
While both procedures aim to restore blood flow to the heart, they are very different in how they are performed and in the recovery journey that follows.
When coronary arteries become narrowed by atherosclerosis, blood flow to the heart muscle can become restricted. This can lead to angina, reduced exercise tolerance and, in some cases, heart attack.
While both procedures aim to improve circulation to the heart, they are very different in how they are performed and in the recovery journey that follows.
What is PCI (Stent)?
Percutaneous Coronary Intervention, is commonly known as angioplasty with stenting, and is a minimally invasive procedure performed through a catheter inserted into an artery often through the right femoral artery at the groin or the right radial artery at the wrist.
A small balloon is used to open the narrowed artery and a stent is placed to help keep the artery open. A PCI is often preferred when:
- Ideal for less complex blockages where one or two coronary arteries are affected;
- Emergency heart attacks requiring immediate revascularisation;
- The blockages are relatively localised;
- Rapid recovery is desirable; or
- Surgery is higher risk to patient.
Recovery is usually quick, with many patients discharged within 24–48 hours and returning to normal activities within 1-3 weeks.
What is CABG (Coronary Artery Bypass Grafting)?
CABG is a form of open-heart surgery that involves a sternotomy (opening of the chest) to access the heart.
During the operation, surgeons use healthy blood vessels taken from elsewhere in the body, often the left internal mammary artery, radial artery, or saphenous vein to create new pathways for blood to flow around blocked coronary arteries.
CABG may be recommended when:
- Multiple coronary arteries are significantly narrowed;
- There is complex coronary disease;
- The left main coronary artery has narrowing; or
- Previous stents have failed
Although recovery is longer, CABG grafts can remain patent for many years. Internal mammary artery grafts, in particular, have been shown to have excellent long-term durability, often lasting 15–25 years or more.
Recovery and Lifestyle Considerations
Another important difference between PCI and CABG is the recovery experience.
PCI‘s are minimally invasive, have a short hospital stay and a quicker return to daily activities.
Whereas:
CABG is major surgery, recovery can take 6-12 weeks allowing for sternotomy healing and post-operative rehabilitation is required.
For some people, the prospect of sternotomy and surgical recovery can feel daunting. Others may prefer the longer-term durability of bypass grafts if their coronary disease is complex.
Individual Decisions Matter
Choosing between PCI and CABG is not simply a medical decision based on angiogram findings alone. It also involves considering:
- The number of coronary arteries affected
- The severity and location of blockages
- Patient’s age and overall health
- Recovery time and lifestyle factors
- Patient preferences and goals
Cardiologists and cardiothoracic surgeons often work together through what is known as the Heart Team approach to determine the most appropriate treatment for each individual patient and the patient also has direct input into the decision making process.
Beyond Procedures: Prevention Still Matters
While these procedures can restore blood flow and improve symptoms, they do not cure coronary artery disease. Your long-term heart health still depends on managing the underlying modifiable risk factors that contribute to atherosclerosis and understanding the power of prevention. Start by looking at how you can manage and modify:
- Smoking and alcohol intake;
- High blood pressure;
- Cholesterol;
- Diabetes;
- Physical inactivity;
- Stress;
- Weight and Obesity.
Final Thought
As someone who spent many years working in cardiology and cardiac rehabilitation, I have seen firsthand how both PCI and CABG can both significantly improve a patients’ quality of life and it indeed is a personal decision. But perhaps the most important lesson I’ve learned time and again is the earlier we address cardiovascular risk factors, the more likely we are to prevent the need for these procedures altogether.
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Health Information Disclaimer: This article provides general health information only and does not constitute medical advice. It should not replace consultation with a qualified healthcare professional regarding individual health concerns.
