What is the difference between CABG and stents?
CABG (bypass surgery) creates new pathways around blocked arteries using grafts, while stents (PCI) open blocked arteries from the inside using balloon-expandable mesh tubes. CABG is major open-heart surgery with 5-7 day hospital stays and 6-12 week recovery. Stenting is minimally invasive, done through a catheter with 1-2 day recovery. However, CABG provides better long-term outcomes for complex coronary disease, particularly with diabetes or left main disease.
The complete answer.
The SYNTAX trial established that anatomy complexity (SYNTAX score) should guide the choice. For low SYNTAX scores (simple disease), PCI and CABG have similar outcomes. For intermediate and high SYNTAX scores (complex, multivessel disease), CABG provides lower rates of repeat revascularization and major cardiac events at 5 and 10 years. The FREEDOM trial showed CABG superiority over PCI in diabetic patients with multivessel disease. The 2021 ACC/AHA guidelines recommend Heart Team discussion for patients with complex coronary disease.
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