CABG vs PCI: How to Choose the Right Treatment for Coronary Artery Disease
CABG vs PCI: How to Choose the Right Treatment for Coronary Artery Disease
Highlighted in Medical News Updates: July 25, 2025
Based on presentations from the AHA Scientific Sessions and related clinical trial publications in 2025.
1. The Clinical Dilemma:
Choosing between CABG (bypass surgery) and PCI (stenting) is one of the most important decisions in treating coronary artery disease (CAD)—the leading cause of death globally.
2. What Each Option Offers:
• CABG is more durable, and better suited for:
• Younger, healthier patients
• Those with diabetes and complex/multivessel disease
• Patients seeking long-term protection from heart attacks
• PCI is less invasive, ideal for:
• Older patients
• Frail individuals with multiple health issues
• Patients with focal or lower-risk disease
3. Mistakes to Avoid:
• Too much PCI is being done in young diabetic patients with complex CAD.
• Too much CABG is performed in elderly, frail patients who may only need symptom relief.
4. Helpful Tools:
Doctors use scoring systems to decide:
• SYNTAX score → Measures coronary anatomy complexity (important for PCI).
• STS score(Society of Thoracic Surgeons (STS) risk score)→ Measures surgical risk (important for CABG).
• Decision rule:
• High SYNTAX + Low STS → CABG preferred
• Low SYNTAX + High STS → PCI preferred
5. Teamwork Is Essential:
Just as the SYNTAX score does not really impact outcome predictions for CABG, the same is true of the STS scores in PCI. The best outcomes happen when cardiologists and surgeons work together as a “heart team”, making shared decisions based on what’s best for the patient, not on specialty preferences.
https://syntaxscore.org/
https://acsdriskcalc.research.sts.org/
