The choice between multiple stents (PCI) and CABG for multivessel coronary artery disease depends on more than just the number of vessels involved.
A few factors matter most: Complexity of the blockages — measured by tools like the SYNTAX score, which factors in how many vessels are affected, where the blockages are, and how complex the lesions are (calcification, bifurcations, total occlusions).
Left main artery involvement — if the left main coronary artery is significantly blocked, CABG is often favored over stenting.
Diabetes — in patients with diabetes and multivessel disease, several major trials (found CABG associated with better long-term outcomes than PCI.
Overall heart function — reduced ejection fraction or heart failure can tip things toward CABG.
Anatomy — some blockages are technically hard to stent well but straightforward for a surgeon to bypass, or vice versa.
Patient factors — age, surgical risk, kidney function, other health conditions, and personal preference (recovery time, invasiveness) all factor in.
As a general pattern: needing several stents across multiple vessels can push a heart team toward recommending CABG, especially with high anatomical complexity or diabetes.
Patients with multivessel disease, however, do well with multi-vessel PCI, particularly if the lesions are less complex or surgical risk is high.