How to address multiple artery blockages with CABG?

Question

Hello doctor,

My father, a 43-year-old male, has been experiencing chest pain and was diagnosed with a heart attack (troponin level 93). An angiography revealed that six arteries are blocked with 75 to 90 percent blockage. However, he is currently experiencing no symptoms, and his daily activities are normal. The doctors have recommended CABG (coronary artery bypass grafting), but we are hesitant about undergoing open-heart surgery.

What should we do next?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Your father recently experienced a heart attack, as indicated by elevated troponin levels. His angiogram shows significant blockages in multiple arteries, including the left main artery and several proximal vessels. His echocardiogram also suggests ischemia, with some reduced heart function due to mild left ventricular dysfunction.

The recommended course of action is early bypass surgery (CABG), which offers complete revascularization and is proven to reduce morbidity, prevent further heart attacks, lower the risk of heart failure, and prevent sudden cardiac arrest and death.

Although your father may feel fine now, the blockages pose a significant risk for future heart attacks or sudden cardiac events. Delaying surgery could negatively impact his long-term health.

CABG is a common and generally safe procedure, with low risks of complications when performed by an experienced surgeon in a specialized center. Given your father’s age (45), bypass surgery is likely to provide longer-term benefits compared to alternatives like percutaneous coronary intervention (PCI) or medical management.

If your father is hesitant about undergoing surgery right away, it is important for him to have a detailed discussion with his physician about the benefits and risks of surgery, along with other options. Stenting (PCI) is another possible option, but it is generally not the first choice in cases with multiple blockages, as it may increase the risk of complications, including stent thrombosis and restenosis.

Alternatively, your father can choose to forgo surgery and continue with medical management. However, even if he is currently asymptomatic, the risks remain high.

Ultimately, his decision should be made after a thorough discussion with his cardiologist, ensuring he fully understands the benefits and risks. No matter what treatment he chooses, maintaining strict adherence to prescribed medications and making lifestyle changes—such as a heart-healthy diet, regular exercise, weight management, smoking cessation, and controlling cholesterol—will be essential for his long-term health.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.