After heart surgery for a major blockage, which procedure leads to fewer future heart attacks?

If you have a major blockage in your main heart artery, you might face a choice between two procedures: getting a stent (PCI) or having bypass surgery (CABG). A big question is which one better protects you from having a heart attack in the years that follow. A major trial followed nearly 1,900 patients for five years to find out. It looked specifically at 'spontaneous' heart attacks—the kind that happen out of the blue, not during the procedure itself. The results show these later heart attacks, while not common, happened more often in patients who got a stent (6.8%) compared to those who had bypass surgery (3.4%). More importantly, when a patient did have one of these spontaneous heart attacks, it was a very strong signal of danger. It was linked to a dramatically higher risk of dying from heart problems or any cause within the next five years. This increased risk was true whether the patient originally had a stent or bypass surgery. The study also found that a very large heart attack during the initial procedure was linked to a higher risk of death, but the link was even stronger for a spontaneous heart attack that happened later. The bottom line: the type of procedure you get for this specific blockage can affect your chances of having a dangerous, late-occurring heart attack, which itself is a major red flag for future health.