Is it better to have a PCI or a bypass operation for coronary artery disease?

Say you've had an angiogram for, you know, angina and you've been found to have some narrowings in some of the arteries to your heart. Are there some situations where an angioplasty, the balloon or the stent is better, in some situations where perhaps a coronary artery bypass or operation is better? It's a very important question. It's something that we often have to make difficult judgments and assessments for the patient, putting together lots of aspects of the patient's care. So what we typically tend to do is once we've performed an angiogram we make an assessment of the totality of the narrowings and we look at the patient, their wishes and their desires and in consideration of any other health concerns that the patient has. If there's one or two arteries that are narrowed and those narrowings are what we consider focal, that means the disease of the arteries in one or two areas, then that is relatively straightforward to treat with stents and we would typically offer that to most of our patients. In certain situations, for example, if the patient has narrowings in key parts of the artery, sometimes in the left main stem or in the proximal part of the LAD artery, these are technical terms but basically represent really important parts of the heart artery, then we may consider surgery. And that's more likely to occur if the patient has diabetes. Now, there's been a lot of different studies that compare bypass surgery with stents. And overall, although the studies vary, we know that in many settings, they can be equivalent, but in the context of diabetes, often surgery gives us a better longer term result because it means the patient doesn't necessarily need to come back for further procedures at a later date. Now we take on board the patient's wishes and their desires, for example, for some people they'd much rather have a day case procedure, have some stents and then in the knowledge that they may need some work later on whereas another person may think I'd much rather have a single operation now and understand that I'm going to be in hospital for some time and it takes a while to get recovered but have a longer period without needing further treatment and so it does require a balance of our views, the patient's views and often in difficult cases where it's hard to decide we have something called a multidisciplinary team meeting or a joint cardiac and cardiothoracic care meeting where we talk with other interventional cardiologists or cardiothoracic surgeons to make a decision together and then we offer our decisions to the patients.