Reports that Parvez Kazi, Salman Khan's body double, underwent heart treatment after doctors found three coronary blockages have once again raised an important question: When does a blocked heart artery actually require a stent or surgery? The discovery of multiple blockages can sound alarming, but cardiologists say the number or percentage of blockages alone does not determine whether a patient needs an intervention. Doctors consider several factors, including the location of the blockage, symptoms, the number of arteries involved, heart function and the overall risk of a heart attack. According to Dr Sameer Bhate, Head of Cardiovascular and Thoracic Surgery, Amrita Hospital, Faridabad, coronary artery disease is a deceptively complicated condition in which the location and nature of a blockage can be more important than the number itself.

Is Every Heart Blockage Dangerous?

"A deceptively complicated topic is raised by reports that Parvez Kazi, Salman Khan's body double, needed immediate heart treatment after three coronary blockages were found: when does a blocked artery necessitate surgery? A percentage by itself cannot provide the solution," says Dr Bhate.

For example, a blockage affecting the left main coronary artery can be particularly serious because this artery supplies blood to a large portion of the heart muscle. On the other hand, a similar degree of narrowing in a smaller peripheral branch may have a different clinical significance. "A smaller, unstable plaque in the left main coronary artery, which supplies a significant percentage of the heart muscle, may have worse consequences than a 70% constriction in a peripheral branch," he explains. Therefore, doctors do not simply count the number of blockages or look at the percentage of narrowing. They assess where the disease is, how severe it is and whether it is affecting blood flow to the heart muscle. The exact details of Kazi's treatment have not been made public.

What Causes Coronary Blockages?

Coronary artery disease usually develops because of atherosclerosis, a process in which fatty deposits, cholesterol and other substances accumulate inside the walls of the arteries. Over time, these plaques can narrow the artery and reduce blood flow to the heart. Sometimes a plaque can rupture suddenly, causing a blood clot that blocks the artery and potentially triggering a heart attack. "When atherosclerotic plaque narrows an artery or abruptly bursts, causing a clot, coronary disease develops," says Dr Bhate. Treatment depends on the patient's individual condition and may include medicines, angioplasty with a stent or coronary artery bypass grafting (CABG).

When Is A Stent Used?

Angioplasty is a minimally invasive procedure in which a catheter is passed through a blood vessel to the affected coronary artery. A balloon may be used to widen the narrowed section, followed by placement of a stent to help keep the artery open. However, finding a blockage on an angiogram does not automatically mean that a stent is required. Doctors may use additional information, including symptoms and tests that determine whether a narrowing is actually restricting blood flow to the heart. The decision is therefore based on the clinical significance of the blockage, rather than simply its appearance on an imaging test.

When Does A Blockage Need Bypass Surgery?

CABG, commonly known as bypass surgery, creates an alternative route for blood to reach the heart muscle. Surgeons use a healthy blood vessel from another part of the body, such as the chest, arm or leg, to bypass the blocked section of the coronary artery. According to Dr Bhate, bypass surgery is generally considered in situations such as significant left-main coronary disease, complex three-vessel disease, diabetes combined with extensive coronary artery disease, reduced heart-pumping function or blockages that may not be suitable for durable stenting. "Another crucial sign is angina that persists even with the best medicines," he says. In other words, persistent symptoms despite appropriate medical treatment can be an important factor in deciding whether an intervention is necessary.

More Blockages Do Not Always Mean More Procedures

One of the biggest misconceptions about coronary disease is that opening every visible blockage must automatically produce a better outcome. But medical treatment can be an important part of managing stable coronary artery disease, and intervention is not necessarily better for every patient. Dr Bhate points to the ISCHEMIA trial, which included more than 5,000 patients with stable coronary disease. The study found that an initial invasive strategy did not significantly reduce major cardiovascular events compared with appropriate medical therapy alone in the overall study population. The choice can become different in certain high-risk groups. For instance, the FREEDOM trial found better outcomes with bypass surgery than stenting among patients with diabetes and multivessel coronary artery disease. At five years, the combined rate of death, heart attack or stroke was 18.7% after bypass surgery compared with 26.6% after stenting. More recent evidence has also added nuance. Five-year results from the FAME 3 trial found that in certain patients with three-vessel coronary disease, contemporary stenting and bypass had similar overall rates of death, stroke or heart attack. However, patients who underwent stenting continued to experience more heart attacks and repeat procedures.

How Do Doctors Decide Between Medicine, Stent And Bypass?

The decision is rarely made on the angiogram alone. A multidisciplinary heart team may consider:

  • The location and complexity of the blockage
  • The number of coronary arteries affected
  • The severity of symptoms
  • Whether symptoms continue despite medicines
  • Diabetes and other medical conditions
  • Heart-pumping function
  • The complexity of the coronary anatomy
  • Whether a stent is technically suitable
  • The expected long-term durability of the treatment

"The evidence refutes the notion that 'more intervention is always better'," says Dr Bhate. This is why two people with seemingly similar percentages of blockage may receive completely different treatment recommendations.

Can Fit People Still Develop Heart Blockages?

Being physically active or having a muscular physique does not eliminate the possibility of coronary artery disease. Risk factors such as age, high cholesterol, high blood pressure, diabetes, smoking, obesity and family history can contribute to coronary disease. Some people may also develop significant disease despite appearing outwardly fit. The important point is that cardiovascular risk cannot be judged by appearance alone.

When Should You Seek Urgent Medical Help?

Coronary artery disease can sometimes remain silent until it becomes serious. Symptoms that warrant urgent medical assessment include:

  • Chest tightness or pressure, especially during exertion
  • Breathlessness
  • Cold sweating
  • Nausea or vomiting
  • Unusual weakness
  • Pain or discomfort spreading to the arm, shoulder, jaw or back
  • Sudden worsening of exercise tolerance

These symptoms should not automatically be dismissed as acidity, fatigue or a lack of fitness. A diagnosis of multiple coronary blockages does not automatically mean that a patient needs bypass surgery or multiple stents. "The precise process used in Kazi's case has not been made public," says Dr Bhate, making it inappropriate to draw conclusions about his treatment from reports of coronary blockages alone.

For patients with coronary artery disease, the key question is not simply "How many blockages are there?" but "Where are they, how significant are they, what symptoms are they causing and which treatment offers the best long-term outcome?" Sometimes the right approach is medication and lifestyle changes. In other cases, angioplasty and stenting may be appropriate. For complex or high-risk coronary disease, bypass surgery may offer greater long-term benefit. When it comes to heart blockages, the right intervention for the right anatomy and the right patient matters more than intervening simply because a blockage is visible.



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