Michael Kim, MD, center, Director of the Coronary Care Unit, runs Mount Sinai Heart's interventional training program — the largest of its kind in the country.
Treatment for Coronary Artery Disease
Mount Sinai's clinical goal for treatment of coronary artery disease (CAD) is simple — establish a well-coordinated plan that includes a close partnership among patients, their health care team, and their family and friends. To maintain heart health, our interdisciplinary team considers a series of factors as they determine your method of treatment. These factors may involve lifestyle changes, medications, and in more advanced cases, surgery and rehabilitation.
Factors that determine your course of treatment for heart disease include:
- Overall health
- Progression of the disease
- Risk factors
- Patient preferences
Mount Sinai Heart has a singularly cooperative approach to treatment, rare among large institutions. Doctors consult with specialists in other divisions and work with nurses and support staff to create treatment plans and foster interdisciplinary communication.
These plans may include:
- Lifestyle modifications to improve damaging effects of risk factors
- Medical therapy to control clot formation, cholesterol, blood pressure, and diabetes
- Interventional cardiology to clear clogged arteries
- Cardiovascular surgery to replace diseased vessels
Taking advantage of the research happening every day at Mount Sinai Heart, our team can enroll patients in research trials for new and groundbreaking treatments not yet available elsewhere.
"Mount Sinai gives individual patients an unsurpassed array of options for both diagnosis and treatment of coronary disease," says Bruce Darrow, MD, PhD, Assistant Professor of Cardiology.
Medical Therapy for Coronary Artery Disease
Medical therapy for coronary artery disease consists of single or combined medications to reduce major factors that contribute to diseased arteries. Medications include:
- Aspirin, which thins blood to prevent clots
- Cholesterol medications, such as statins, which can reduce and even reverse the buildup of plaques
- Beta blockers, which improve blood flow by reducing the heart's need for oxygen
- Nitroglycerin, which opens the coronary arteries to increase blood flow to the heart
- ACE inhibitors, which lower blood pressure and allow more blood to get to the heart
- Calcium channel blockers, which relax and open the muscle around the coronary artery
- Emerging therapies such as the polypill, an exciting advancement from Mount Sinai Heart that is currently being tested worldwide
Angioplasty and Stents
Angioplasty and Stents
Those with more advanced heart disease may require more aggressive approaches, such as clearing blocked arteries through angioplasty and shoring up diseased vessels with stents.
"For many patients, angioplasty and stenting ends up being the best option, and Mount Sinai cardiologists have a proven track record," says Michael Kim, MD, Assistant Professor of Cardiology and Director of the Coronary Care Unit.
Michael Kim, MD, Assistant Professor of Cardiology, Director of the Coronary Care Unit, and Director of Medical Education in the Cardiac Catheterization Laboratory, has been leading an effort to increase the frequency of same-day angioplasty procedures. As the principal investigator for a national multicenter study testing the procedure, he is seeing excellent results in qualified patients.
"The patients are happier going home the same day. The procedure is just as safe as an overnight stay," Dr. Kim says. "We have performed same-day angioplasty for about eight years now. About 15 percent of our younger patients with uncomplicated angioplasties are home about six hours later — that's about 1,000 patients a year."
When it comes to angioplasty and stenting, Mount Sinai once again proves itself a national vanguard.
"Less than 5 percent of the interventional heart centers in the United States are sending patients home the same day," says Dr. Kim. "Mount Sinai Heart is the leader in the entire country in this."
Cardiac Catheterization Laboratory / Interventional Cardiology
Patients travel from around the world to receive treatment from the interventional cardiologists at Mount Sinai's Cardiac Catheterization Laboratory. Headed by Samin K. Sharma, MD, Professor of Cardiology, the Mount Sinai Heart Catheterization Laboratory performs more procedures than any other hospital in the United States. Dr. Sharma has held New York State's highest angioplasty success rate since 1994.
"Our Cardiac Catheterization Laboratory is open every hour of every day," says Dr. Sharma. "We treat more than 14,000 cases every year. We are one of the most experienced centers in the country and have one of the lowest complication rates in the New York tri-state area."
For tough blockages, interventional cardiologists have developed a unique treatment, known as rotational atherectomy, in which they use a tiny, fast-spinning blade to scrape away arterial plaques to improve blood flow. Mount Sinai's success rate with this technique is so high that we receive frequent referrals from other hospitals in the Northeast.
Coronary Artery ByPass Graft
Heart Bypass Surgery
Sometimes coronary artery bypass graft surgery (CABG) is the best option for people with coronary artery disease. In this procedure, surgeons replace diseased arteries with healthy ones. Blood vessels removed from the chest, legs, or arms find a new home in the heart, keeping it well nourished.
Our top-tier surgeons in coronary artery bypass graft procedures have revolutionized the treatment of certain high-risk CAD patients.
"We have tremendous experience here in performing coronary bypass surgery, not only in healthier patients, but also in those with other serious medical conditions, including kidney and liver disease," says Farzan Filsoufi, MD, Associate Professor of Cardiothoracic Surgery and Associate Chief of Cardiac Surgery.
Mount Sinai Heart features the daVinci Surgical System, a robotic device surgeons use to perform minimally invasive bypass surgery. The technology makes use of fingertip-size incisions, allowing patients a shorter hospital stay and a speedier recovery.
Another effort underway at Mount Sinai Heart is the use of off-pump bypass, or "beating heart" surgery. Surgeons often perform bypass surgery using a heart-lung machine, which stops the heart from beating, allowing surgeons to operate on a motionless, blood-free surface. The machine draws blood out of the heart and sends it to an artificial lung outside the body, where it receives oxygen. The newly oxygenated blood is then sent back into the bloodstream through the aorta, where it circulates throughout the rest of the body.
"For the right patients, off-pump graft surgery is a better option than conventional surgery," says Ramachandra C. Reddy, MD, Assistant Professor of Cardiothoracic Surgery. For this type of surgery, the heart-lung machine is not used. Using stabilizing techniques, the surgeon grafts the bypass onto the heart while it continues to beat.
Off-pump bypass surgery offers many benefits, including a reduced need for blood transfusions; less risk of bleeding, stroke, and kidney failure, and reduced chance of nerve damage. Hospital stays are shorter, and patients can make a quicker return to day-to-day activities.