Coronary Artery Disease: Should I Have Angioplasty for Stable Angina?

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You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Coronary Artery Disease: Should I Have Angioplasty for Stable Angina?

Get the facts

Your options

  • Have angioplasty for stable angina, along with taking medicines and making healthy lifestyle changes.
  • Take medicines and make lifestyle changes to treat stable angina. This is called medical therapy.

This decision aid is for people who have coronary artery disease and stable angina. This means that your angina symptoms, such as chest pain or pressure, happen at times you can predict. They happen when your heart is working hard, such as during exercise. Your symptoms go away when you rest or after you take nitroglycerin.

Key points to remember

  • Both medical therapy alone (lifestyle changes and taking medicines) and angioplasty plus medical therapy can relieve angina. Angioplasty improves angina sooner.
  • Angioplasty has a risk of heart attack, stroke, and death. But these rarely happen.
  • Medical therapy alone and angioplasty with medical therapy work about the same to prevent heart attacks and help people live longer.
  • Whichever treatment you choose, you will still need to take medicines and make lifestyle changes. This will give you the best chance for a longer, healthier life.
  • You don't need to make this decision right away. You can keep trying medical therapy. Your doctor may adjust your medicine to try to relieve your angina. You could have angioplasty later if your angina symptoms still bother you too much.
FAQs

What is angioplasty?

Angioplasty is a procedure to restore blood flow in narrowed coronary arteries.

During angioplasty, the doctor puts a thin, flexible tube called a catheter into an artery in your groin or arm. The doctor guides the tube into the narrowed coronary artery. Dye is put into the catheter to make the artery show up on an X-ray. This helps the doctor see narrow parts that limit blood flow.

The doctor uses the catheter to put a small balloon into the narrowed part of the artery. The doctor expands the balloon for a short time. This widens the artery to allow blood to flow more easily. The doctor may put a small, expandable tube called a stent in the artery to keep it open.

Before the procedure, you may get medicine that relaxes you or puts you in a light sleep. The area where the catheter is put in will be numb. You may feel a brief sting or pinch from the numbing medicine. Most people do not have pain when the catheter is in the blood vessel. You will probably feel some warmth when the dye is put in.

The procedure can take a few hours. This includes the time to get ready for the procedure and the time to recover after it. You will likely stay in the hospital for a night. After you leave the hospital, you will need to limit your activity for a day or two.

Treatment after angioplasty

It's important to continue medical therapy. This includes making lifestyle changes and taking medicines to prevent a heart attack and stroke.

If you get a stent, you will probably take aspirin plus another medicine to prevent blood clots. How long you will take the medicines depends on the type of stent you have. If your stent is coated with medicine to prevent clots, you will probably take both medicines for at least 6 months. If your stent is bare metal, you will take both medicines for at least 1 month. After that, you will likely keep taking daily aspirin.

If you have a high risk of bleeding, your doctor may shorten the time you take these medicines. You can work with your doctor to decide how long you will take both of these medicines.

You may still need medicine such as nitroglycerin when you have angina symptoms. But you may not need to take it as often.

It's important to not smoke and to eat a heart-healthy diet. You also will be encouraged to be physically active.

What is medical therapy for stable angina?

Medical therapy includes taking medicines and making lifestyle changes. Medical therapy is important for all people who have heart disease. Whatever choice you make about angioplasty, medical therapy will give you the best chance of keeping heart disease from getting worse. It can help you prevent a heart attack and live longer. And it also can help relieve angina symptoms.

Medicines

You take medicines to prevent a heart attack. These include aspirin and medicines to lower blood pressure and cholesterol. You also may take nitroglycerin to relieve angina symptoms.

Lifestyle changes

Lifestyle changes include eating a healthy diet, not smoking, and getting daily exercise. Changing your habits may take some time. But it could keep your heart disease from getting worse. It could even reverse some of the damage.

Your doctor will ask you to:

  • Stop smoking. Quitting smoking can greatly lower your chance of having a heart attack and dying.
  • Be active for at least 30 minutes on all or most days of the week.
  • Eat heart-healthy food. This includes lots of fruits and vegetables, whole grains, and lean protein. Try to eat fish at least 2 times a week.
  • Stay at a healthy weight. Lose weight if you need to.
  • Manage other health problems, including diabetes, high blood pressure, and high cholesterol.

Why might you have angioplasty?

You may have had tests such as an exercise stress test or a coronary angiogram to see if you have narrowing of your heart arteries. If you do have narrowing, you may decide to have angioplasty because you want relief from angina symptoms. Angioplasty can improve symptoms for people who have stable angina. (Stable angina means that you can usually predict when your symptoms will happen. You probably know what things cause your angina. For example, you know how much activity usually causes your angina. You also know how to relieve your symptoms.)

Your doctor may suggest angioplasty if:

  • Your angina symptoms keep you from enjoying your activities and your life.
  • Medical therapy hasn't improved your angina enough.

It's important to talk with your doctor about your symptoms. Do they limit your daily activities and make it hard to enjoy your life? Do you have angina during light physical activity, such as walking a couple of blocks or up stairs? Also, if you are taking medicine for angina, let your doctor know if it doesn't control your symptoms enough.

Your doctor may do some other tests to make sure that angioplasty is a good choice for you. For example, your doctor may check:

  • To see if narrowed arteries are limiting blood flow to your heart and causing angina.
  • Which arteries—and how many—are narrowed. The doctor also will see how badly your arteries are narrowed. These tests can help your doctor see if bypass surgery might be a better choice for you.

You don't have to decide right away whether to have angioplasty. You could decide later to have it.

What are the benefits of angioplasty?

Angioplasty can improve your angina symptoms. It might not relieve all of your symptoms. But you might not need to take angina medicines anymore. Or you might not need to take as much.

There are some things that angioplasty can't do. In people who have stable angina:footnote 1, footnote 2

  • It won't prevent a heart attack any more than medicines and lifestyle changes do.
  • It won't help you live any longer than medicines and lifestyle changes do.

It may be hard to understand why angioplasty does not lower your risk of a heart attack more than medical therapy does. It's because of how heart disease and plaque happen in your arteries.

Even if you get a stent, you still may have other places in your arteries where a heart attack can happen. During the procedure, your doctor finds and treats the places where plaque narrows the artery and limits blood flow. But smaller plaques can build up in other places in your arteries. They don't limit blood flow much or cause symptoms. But if one ruptures, it can cause a heart attack. This type of plaque is treated with medicines to lower cholesterol.

What are the risks of angioplasty?

Angioplasty has some risks. They include:

  • The need for emergency bypass surgery during the procedure.
  • Heart attack.
  • Stroke.
  • Death.

Your age and health affect your risk of problems. For example, older people or those with heart failure or kidney disease have a higher risk of problems. Your doctor can help you know your risk.

The risks of problems where the catheter was placed include:

  • Bleeding.
  • Damage to blood vessels.
  • Pain.
  • Swelling.
  • Bruising.
  • Tenderness.

Over time, there is a chance that blood vessels with stents can close. There also is a chance that you'll need another angioplasty or a bypass surgery.

Radiation: There is always a slight risk of damage to cells or tissues from being exposed to any radiation. This includes the low levels of X-ray used for this procedure. But the risk of damage from the X-rays is usually very low compared with the possible benefits of the procedure.

What do numbers tell us about benefits and risks of angioplasty?

Benefits

Number of people with no angina after treatment footnote 3
  After 3 months After 2 years After 3 years
Angioplasty plus medical therapy 53 out of 100 59 out of 100 59 out of 100
Medical therapy 42 out of 100 53 out of 100 56 out of 100

*Based on the best available evidence (evidence quality: moderate)

Both medical therapy alone (lifestyle changes and taking medicines) and angioplasty plus medical therapy can relieve angina. Angioplasty improves angina sooner. But over time, both treatments work about the same to ease symptoms and improve quality of life.footnote 3

Take 100 people who have angioplasty :

  • After 3 months:
    • 53 out of 100 of people who had angioplasty plus medical therapy had no angina symptoms. That means 47 out of 100 had symptoms.
    • 42 out of 100 people who had medical therapy alone had no symptoms. That means 58 out of 100 did have symptoms.
  • After 2 years:
    • 59 out of 100 people who had the procedure and medical therapy had no symptoms. That means 41 out of 100 had symptoms.
    • 53 out of 100 people who had medical therapy alone had no symptoms. That means 47 out of 100 had symptoms.
  • After 3 years:
    • 59 out of 100 people who had the procedure and medical therapy had no symptoms. That means 41 out of 100 had symptoms.
    • 56 out of 100 who had medical therapy alone had no symptoms. That means 44 out of 100 had symptoms.

*Based on the best available evidence (evidence quality: moderate)

Doctors usually recommend that you try medical therapy first. This may include changing the dose of medicines or trying new medicines.

Medical therapy doesn't always work to relieve symptoms. But it does help to prevent a heart attack. You may decide later to have angioplasty if you still have symptoms that keep you from doing your activities.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence.footnote 3 The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

The following numbers about risks come from problems seen in patients in hospitals.

Risks

Take 100 people who have angioplasty . They have the following risks:

Examples of angioplasty risks* footnote 4, footnote 5
Possible problems from the procedure How many people had this problem
Damage to the blood vessel where catheter is put in About 1 out of 100
Damage to the coronary artery About 1 to 2 out of 100
Stroke About 1 out of 100
Emergency bypass surgery About 1 out of 100
Death in the hospitalfootnote 6 About 1 out of 100

*Based on rates of complications from patients.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have angioplasty, along with taking medicines and making lifestyle changes Have angioplasty, along with taking medicines and making lifestyle changes
  • You may stay in the hospital for a night. At home, you do only light activity for a day or two.
  • You take medicines to help prevent heart attack or stroke.
  • If you get a stent, you will take aspirin and another medicine to prevent blood clots.
  • You make lifestyle changes. These include exercising, eating a heart-healthy diet, staying at a healthy weight, and quitting smoking.
  • You manage other health problems, including diabetes, high blood pressure, and high cholesterol.
  • Angioplasty can relieve angina.
  • Angioplasty with medical therapy can improve your quality of life and help you live longer.
  • Angioplasty carries the risk of heart attack, stroke, and death. Emergency bypass surgery during the procedure also is a risk. Your chances of having a serious problem increase with age. The risk also increases if you have certain health conditions.
  • You may have side effects, including the risk of bleeding. Bleeding can happen from blood-thinning medicines given after a stent is placed.
Take medicines and make lifestyle changes only (medical therapy) Take medicines and make lifestyle changes only (medical therapy)
  • You make lifestyle changes. These include exercising, eating a heart-healthy diet, staying at a healthy weight, and quitting smoking.
  • You manage other health problems, such as diabetes, high blood pressure, and high cholesterol.
  • You take medicines to help prevent heart attack or stroke.
  • You also may take medicine to relieve angina.
  • Medical therapy can relieve angina symptoms.
  • Medical therapy can improve your quality of life and help you live longer.
  • You may have side effects from medicines, including the risk of bleeding.
  • Medical therapy might not relieve angina as soon as you want. You may decide later that you want angioplasty.

Personal stories about deciding to have angioplasty for stable angina

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

My chest pain bothers me sometimes. My doctor and I talked about it, and we decided that I could change my dose or maybe try another angina medicine. And I could take better care of myself. At my age, any procedure has extra risks, so I want to try the other stuff first.

Rodrigo, age 75

I love to take hikes with my daughter and grandchildren. And I love to travel. But I can't walk very far, because my chest hurts. Even though I have been taking my medicines and trying to eat well and exercise, my pain is still there. My doctor and I agreed that angioplasty may be a good choice for me.

Margie, age 62

I have some angina symptoms, but they don't bother me very often. I mostly want to lower my risk of a heart attack. And angioplasty won't do that. So I'm going to try to keep eating better, being active, and taking my medicines.

Susan, age 56

I've had angina for a while now. I usually take nitroglycerin for it, along with my other medicines. But lately I've had more pain when I do chores around the house or play golf. My doctor said angioplasty might be an option because I have a couple of narrowed arteries. So I'm going to have it. I'll still have to watch what I eat, get some exercise, and take my medicines.

Frank, age 60

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose angioplasty

Reasons to choose medical therapy

I have angina symptoms that keep me from doing my activities and enjoying my life.

My angina doesn't keep me from my activities and from enjoying my life.

More important
Equally important
More important

I would rather take less medicine for angina.

I don't mind taking medicine for angina.

More important
Equally important
More important

I'm not worried about the risks of angioplasty.

I'm worried about the risks of angioplasty.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Angioplasty

Medical therapy

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, Do you still have to take medicines for your heart if you have angioplasty?
2, If you keep trying medical therapy now, can you still have angioplasty later?
3, Does angioplasty have serious risks?

Decide what's next

1, Do you understand the options available to you?
2, Are you clear about which benefits and side effects matter most to you?
3, Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

Credits and References

Credits
Author Healthwise Staff
Primary Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Primary Medical Reviewer Martin J. Gabica, MD - Family Medicine
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer Robert A. Kloner, MD, PhD - Cardiology
Specialist Medical Reviewer John B. Wong, MD - Internal Medicine

References
Citations
  1. Boden WE, et al. (2007). Optimal medical therapy with or without PCI for stable coronary disease. New England Journal of Medicine, 356(15): 1503–1516.
  2. Sedlis SP, et al. (2015). Effect of PCI on long-term survival in patients with stable ischemic heart disease. New England Journal of Medicine, 373(20): 1937–1946. DOI: 10.1056/NEJMoa1505532. Accessed November 12, 2015.
  3. Weintraub W, et al. (2008). Effect of PCI on quality of life in patients with stable coronary artery disease. New England Journal of Medicine, 359(7): 677-687.
  4. Bashore TM, et al. (2012). 2012 ACCF/SCAI Expert consensus document on cardiac catheterization laboratory standards update. Journal of the American College of Cardiology, 59(24): 2221–2305.
  5. Subherwal S, et al. (2012). Temporal trends in and factors associated with bleeding complications among patients undergoing percutaneous coronary intervention. Journal of the American College of Cardiology, 59(21): 1861–1869. DOI: 10.1016/j.jacc.2011.12.046. Accessed October 16, 2015.
  6. Brennan JM, et al. (2013). Enhanced mortality risk prediction with a focus on high-risk percutaneous coronary intervention. Journal of the American College of Cardiology Cardiovascular Interventions, 6(8): 790–799. DOI:10.1016/j.jcin.2013.03.020. Accessed October 17, 2015.
Other Works Consulted
  • Douglas JS, King SB (2011). Percutaneous coronary intervention. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 2, pp. 1430–1457. New York: McGraw-Hill.
  • Fihn SD, et al. (2014). 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation. DOI: 10.1161/CIR.0000000000000095. Accessed October 13, 2014.
  • Levine GN, et al. (2011). 2011 ACC/AHA/SCAI Guideline for percutaneous coronary intervention: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation, 124(23): e574–e651.
  • Levine GN, et al. (2016). 2016 ACC/AHA Guideline focused update on duration of dual antiplatelet therapy in patient with coronary artery disease. Circulation, published online March 29, 2016. DOI: 10.1161/CIR.0000000000000404. Accessed March 29, 2016.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Coronary Artery Disease: Should I Have Angioplasty for Stable Angina?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Have angioplasty for stable angina, along with taking medicines and making healthy lifestyle changes.
  • Take medicines and make lifestyle changes to treat stable angina. This is called medical therapy.

This decision aid is for people who have coronary artery disease and stable angina. This means that your angina symptoms, such as chest pain or pressure, happen at times you can predict. They happen when your heart is working hard, such as during exercise. Your symptoms go away when you rest or after you take nitroglycerin.

Key points to remember

  • Both medical therapy alone (lifestyle changes and taking medicines) and angioplasty plus medical therapy can relieve angina. Angioplasty improves angina sooner.
  • Angioplasty has a risk of heart attack, stroke, and death. But these rarely happen.
  • Medical therapy alone and angioplasty with medical therapy work about the same to prevent heart attacks and help people live longer.
  • Whichever treatment you choose, you will still need to take medicines and make lifestyle changes. This will give you the best chance for a longer, healthier life.
  • You don't need to make this decision right away. You can keep trying medical therapy. Your doctor may adjust your medicine to try to relieve your angina. You could have angioplasty later if your angina symptoms still bother you too much.
FAQs

What is angioplasty?

Angioplasty is a procedure to restore blood flow in narrowed coronary arteries.

During angioplasty , the doctor puts a thin, flexible tube called a catheter into an artery in your groin or arm. The doctor guides the tube into the narrowed coronary artery. Dye is put into the catheter to make the artery show up on an X-ray. This helps the doctor see narrow parts that limit blood flow.

The doctor uses the catheter to put a small balloon into the narrowed part of the artery. The doctor expands the balloon for a short time. This widens the artery to allow blood to flow more easily. The doctor may put a small, expandable tube called a stent in the artery to keep it open.

Before the procedure, you may get medicine that relaxes you or puts you in a light sleep. The area where the catheter is put in will be numb. You may feel a brief sting or pinch from the numbing medicine. Most people do not have pain when the catheter is in the blood vessel. You will probably feel some warmth when the dye is put in.

The procedure can take a few hours. This includes the time to get ready for the procedure and the time to recover after it. You will likely stay in the hospital for a night. After you leave the hospital, you will need to limit your activity for a day or two.

Treatment after angioplasty

It's important to continue medical therapy. This includes making lifestyle changes and taking medicines to prevent a heart attack and stroke.

If you get a stent, you will probably take aspirin plus another medicine to prevent blood clots. How long you will take the medicines depends on the type of stent you have. If your stent is coated with medicine to prevent clots, you will probably take both medicines for at least 6 months. If your stent is bare metal, you will take both medicines for at least 1 month. After that, you will likely keep taking daily aspirin.

If you have a high risk of bleeding, your doctor may shorten the time you take these medicines. You can work with your doctor to decide how long you will take both of these medicines.

You may still need medicine such as nitroglycerin when you have angina symptoms. But you may not need to take it as often.

It's important to not smoke and to eat a heart-healthy diet. You also will be encouraged to be physically active.

What is medical therapy for stable angina?

Medical therapy includes taking medicines and making lifestyle changes. Medical therapy is important for all people who have heart disease. Whatever choice you make about angioplasty, medical therapy will give you the best chance of keeping heart disease from getting worse. It can help you prevent a heart attack and live longer. And it also can help relieve angina symptoms.

Medicines

You take medicines to prevent a heart attack. These include aspirin and medicines to lower blood pressure and cholesterol. You also may take nitroglycerin to relieve angina symptoms.

Lifestyle changes

Lifestyle changes include eating a healthy diet, not smoking, and getting daily exercise. Changing your habits may take some time. But it could keep your heart disease from getting worse. It could even reverse some of the damage.

Your doctor will ask you to:

  • Stop smoking. Quitting smoking can greatly lower your chance of having a heart attack and dying.
  • Be active for at least 30 minutes on all or most days of the week.
  • Eat heart-healthy food. This includes lots of fruits and vegetables, whole grains, and lean protein. Try to eat fish at least 2 times a week.
  • Stay at a healthy weight. Lose weight if you need to.
  • Manage other health problems, including diabetes, high blood pressure, and high cholesterol.

Why might you have angioplasty?

You may have had tests such as an exercise stress test or a coronary angiogram to see if you have narrowing of your heart arteries. If you do have narrowing, you may decide to have angioplasty because you want relief from angina symptoms. Angioplasty can improve symptoms for people who have stable angina. (Stable angina means that you can usually predict when your symptoms will happen. You probably know what things cause your angina. For example, you know how much activity usually causes your angina. You also know how to relieve your symptoms.)

Your doctor may suggest angioplasty if:

  • Your angina symptoms keep you from enjoying your activities and your life.
  • Medical therapy hasn't improved your angina enough.

It's important to talk with your doctor about your symptoms. Do they limit your daily activities and make it hard to enjoy your life? Do you have angina during light physical activity, such as walking a couple of blocks or up stairs? Also, if you are taking medicine for angina, let your doctor know if it doesn't control your symptoms enough.

Your doctor may do some other tests to make sure that angioplasty is a good choice for you. For example, your doctor may check:

  • To see if narrowed arteries are limiting blood flow to your heart and causing angina.
  • Which arteries—and how many—are narrowed. The doctor also will see how badly your arteries are narrowed. These tests can help your doctor see if bypass surgery might be a better choice for you.

You don't have to decide right away whether to have angioplasty. You could decide later to have it.

What are the benefits of angioplasty?

Angioplasty can improve your angina symptoms. It might not relieve all of your symptoms. But you might not need to take angina medicines anymore. Or you might not need to take as much.

There are some things that angioplasty can't do. In people who have stable angina:1, 2

  • It won't prevent a heart attack any more than medicines and lifestyle changes do.
  • It won't help you live any longer than medicines and lifestyle changes do.

It may be hard to understand why angioplasty does not lower your risk of a heart attack more than medical therapy does. It's because of how heart disease and plaque happen in your arteries.

Even if you get a stent, you still may have other places in your arteries where a heart attack can happen. During the procedure, your doctor finds and treats the places where plaque narrows the artery and limits blood flow. But smaller plaques can build up in other places in your arteries. They don't limit blood flow much or cause symptoms. But if one ruptures, it can cause a heart attack. This type of plaque is treated with medicines to lower cholesterol.

What are the risks of angioplasty?

Angioplasty has some risks. They include:

  • The need for emergency bypass surgery during the procedure.
  • Heart attack.
  • Stroke.
  • Death.

Your age and health affect your risk of problems. For example, older people or those with heart failure or kidney disease have a higher risk of problems. Your doctor can help you know your risk.

The risks of problems where the catheter was placed include:

  • Bleeding.
  • Damage to blood vessels.
  • Pain.
  • Swelling.
  • Bruising.
  • Tenderness.

Over time, there is a chance that blood vessels with stents can close. There also is a chance that you'll need another angioplasty or a bypass surgery.

Radiation: There is always a slight risk of damage to cells or tissues from being exposed to any radiation. This includes the low levels of X-ray used for this procedure. But the risk of damage from the X-rays is usually very low compared with the possible benefits of the procedure.

What do numbers tell us about benefits and risks of angioplasty?

Benefits

Number of people with no angina after treatment 3
  After 3 months After 2 years After 3 years
Angioplasty plus medical therapy 53 out of 100 59 out of 100 59 out of 100
Medical therapy 42 out of 100 53 out of 100 56 out of 100

*Based on the best available evidence (evidence quality: moderate)

Both medical therapy alone (lifestyle changes and taking medicines) and angioplasty plus medical therapy can relieve angina. Angioplasty improves angina sooner. But over time, both treatments work about the same to ease symptoms and improve quality of life.3

Take 100 people who have angioplasty :

  • After 3 months:
    • 53 out of 100 of people who had angioplasty plus medical therapy had no angina symptoms. That means 47 out of 100 had symptoms.
    • 42 out of 100 people who had medical therapy alone had no symptoms. That means 58 out of 100 did have symptoms.
  • After 2 years:
    • 59 out of 100 people who had the procedure and medical therapy had no symptoms. That means 41 out of 100 had symptoms.
    • 53 out of 100 people who had medical therapy alone had no symptoms. That means 47 out of 100 had symptoms.
  • After 3 years:
    • 59 out of 100 people who had the procedure and medical therapy had no symptoms. That means 41 out of 100 had symptoms.
    • 56 out of 100 who had medical therapy alone had no symptoms. That means 44 out of 100 had symptoms.

*Based on the best available evidence (evidence quality: moderate)

Doctors usually recommend that you try medical therapy first. This may include changing the dose of medicines or trying new medicines.

Medical therapy doesn't always work to relieve symptoms. But it does help to prevent a heart attack. You may decide later to have angioplasty if you still have symptoms that keep you from doing your activities.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence.3 The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

The following numbers about risks come from problems seen in patients in hospitals.

Risks

Take 100 people who have angioplasty . They have the following risks:

Examples of angioplasty risks* 4, 5
Possible problems from the procedure How many people had this problem
Damage to the blood vessel where catheter is put in About 1 out of 100
Damage to the coronary artery About 1 to 2 out of 100
Stroke About 1 out of 100
Emergency bypass surgery About 1 out of 100
Death in the hospitalfootnote 6 About 1 out of 100

*Based on rates of complications from patients.

2. Compare your options

  Have angioplasty, along with taking medicines and making lifestyle changes Take medicines and make lifestyle changes only (medical therapy)
What is usually involved?
  • You may stay in the hospital for a night. At home, you do only light activity for a day or two.
  • You take medicines to help prevent heart attack or stroke.
  • If you get a stent, you will take aspirin and another medicine to prevent blood clots.
  • You make lifestyle changes. These include exercising, eating a heart-healthy diet, staying at a healthy weight, and quitting smoking.
  • You manage other health problems, including diabetes, high blood pressure, and high cholesterol.
  • You make lifestyle changes. These include exercising, eating a heart-healthy diet, staying at a healthy weight, and quitting smoking.
  • You manage other health problems, such as diabetes, high blood pressure, and high cholesterol.
  • You take medicines to help prevent heart attack or stroke.
  • You also may take medicine to relieve angina.
What are the benefits?
  • Angioplasty can relieve angina.
  • Angioplasty with medical therapy can improve your quality of life and help you live longer.
  • Medical therapy can relieve angina symptoms.
  • Medical therapy can improve your quality of life and help you live longer.
What are the risks and side effects?
  • Angioplasty carries the risk of heart attack, stroke, and death. Emergency bypass surgery during the procedure also is a risk. Your chances of having a serious problem increase with age. The risk also increases if you have certain health conditions.
  • You may have side effects, including the risk of bleeding. Bleeding can happen from blood-thinning medicines given after a stent is placed.
  • You may have side effects from medicines, including the risk of bleeding.
  • Medical therapy might not relieve angina as soon as you want. You may decide later that you want angioplasty.

Personal stories

Personal stories about deciding to have angioplasty for stable angina

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"My chest pain bothers me sometimes. My doctor and I talked about it, and we decided that I could change my dose or maybe try another angina medicine. And I could take better care of myself. At my age, any procedure has extra risks, so I want to try the other stuff first."

— Rodrigo, age 75

"I love to take hikes with my daughter and grandchildren. And I love to travel. But I can't walk very far, because my chest hurts. Even though I have been taking my medicines and trying to eat well and exercise, my pain is still there. My doctor and I agreed that angioplasty may be a good choice for me."

— Margie, age 62

"I have some angina symptoms, but they don't bother me very often. I mostly want to lower my risk of a heart attack. And angioplasty won't do that. So I'm going to try to keep eating better, being active, and taking my medicines."

— Susan, age 56

"I've had angina for a while now. I usually take nitroglycerin for it, along with my other medicines. But lately I've had more pain when I do chores around the house or play golf. My doctor said angioplasty might be an option because I have a couple of narrowed arteries. So I'm going to have it. I'll still have to watch what I eat, get some exercise, and take my medicines."

— Frank, age 60

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose angioplasty

Reasons to choose medical therapy

I have angina symptoms that keep me from doing my activities and enjoying my life.

My angina doesn't keep me from my activities and from enjoying my life.

             
More important
Equally important
More important

I would rather take less medicine for angina.

I don't mind taking medicine for angina.

             
More important
Equally important
More important

I'm not worried about the risks of angioplasty.

I'm worried about the risks of angioplasty.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Angioplasty

Medical therapy

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Do you still have to take medicines for your heart if you have angioplasty?

  • Yes
  • No
  • I'm not sure
You're right. If you choose angioplasty, you will still need to take medicines to reduce your risk of a heart attack or stroke.

2. If you keep trying medical therapy now, can you still have angioplasty later?

  • Yes
  • No
  • I'm not sure
You're right. If you decide to try medical therapy now, you can still have angioplasty later if your angina symptoms bother you too much.

3. Does angioplasty have serious risks?

  • Yes
  • No
  • I'm not sure
You're right. Angioplasty carries the risk of heart attack, stroke, and death. Your chances of having a serious problem increase with age.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.
 
Credits
By Healthwise Staff
Primary Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Primary Medical Reviewer Martin J. Gabica, MD - Family Medicine
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer Robert A. Kloner, MD, PhD - Cardiology
Specialist Medical Reviewer John B. Wong, MD - Internal Medicine

References
Citations
  1. Boden WE, et al. (2007). Optimal medical therapy with or without PCI for stable coronary disease. New England Journal of Medicine, 356(15): 1503–1516.
  2. Sedlis SP, et al. (2015). Effect of PCI on long-term survival in patients with stable ischemic heart disease. New England Journal of Medicine, 373(20): 1937–1946. DOI: 10.1056/NEJMoa1505532. Accessed November 12, 2015.
  3. Weintraub W, et al. (2008). Effect of PCI on quality of life in patients with stable coronary artery disease. New England Journal of Medicine, 359(7): 677-687.
  4. Bashore TM, et al. (2012). 2012 ACCF/SCAI Expert consensus document on cardiac catheterization laboratory standards update. Journal of the American College of Cardiology, 59(24): 2221–2305.
  5. Subherwal S, et al. (2012). Temporal trends in and factors associated with bleeding complications among patients undergoing percutaneous coronary intervention. Journal of the American College of Cardiology, 59(21): 1861–1869. DOI: 10.1016/j.jacc.2011.12.046. Accessed October 16, 2015.
  6. Brennan JM, et al. (2013). Enhanced mortality risk prediction with a focus on high-risk percutaneous coronary intervention. Journal of the American College of Cardiology Cardiovascular Interventions, 6(8): 790–799. DOI:10.1016/j.jcin.2013.03.020. Accessed October 17, 2015.
Other Works Consulted
  • Douglas JS, King SB (2011). Percutaneous coronary intervention. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 2, pp. 1430–1457. New York: McGraw-Hill.
  • Fihn SD, et al. (2014). 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation. DOI: 10.1161/CIR.0000000000000095. Accessed October 13, 2014.
  • Levine GN, et al. (2011). 2011 ACC/AHA/SCAI Guideline for percutaneous coronary intervention: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation, 124(23): e574–e651.
  • Levine GN, et al. (2016). 2016 ACC/AHA Guideline focused update on duration of dual antiplatelet therapy in patient with coronary artery disease. Circulation, published online March 29, 2016. DOI: 10.1161/CIR.0000000000000404. Accessed March 29, 2016.

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