Surgery & Perioperative/Cardiaclow yield

Coronary revascularisation (CABG vs PCI)

also: CABG · coronary artery bypass · PCI · stent

Overview

Restoring coronary blood flow — by stent (PCI) or bypass graft (CABG). The choice between them is a classic decision.

Mechanism

PCI = balloon + drug-eluting stent via catheter (less invasive, repeat-prone). CABG = grafting (LIMA to LAD ± vein grafts) bypassing stenoses (more durable, better for complex/multivessel disease).

Indications

ACS/STEMI: primary PCI
Stable angina refractory to medical therapy
CABG favoured: left-main disease, triple-vessel disease (esp. diabetes), complex anatomy

The agents

PCIpercutaneous stent

Primary PCI for STEMI; single-vessel disease.

CABGbypass graft

Left-main/triple-vessel, diabetics; needs DAPT/antiplatelet planning.

Adverse effects

PCI: in-stent restenosis / thrombosiscommon

CABG: stroke, AF, sternal wound infectionserious

Bleeding (antiplatelet/anticoagulation)common

Cautions & contraindications

—all

Choice is anatomy- + comorbidity-driven (Heart Team).

Choosing it

Angina despite medical therapy, or significant left-main / triple-vessel disease (especially with diabetes) on angiography.

Source: NICE — Stable angina / ACS