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Coronary Artery Disease: Should I Have Angioplasty for Stable Angina?
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.
1Get the | 2Compare | 3Your | 4Your | 5Quiz | 6Your |
Get the facts
Your options
- Have angioplasty for stable angina, along with taking medicines and having a heart-healthy lifestyle.
- Take medicines and have a heart-healthy lifestyle to treat stable angina. This is called medical therapy.
This decision aid is for people who:
- Have stable angina. This means you can usually predict when your symptoms will happen.
- Have already tried medicines for angina symptoms.
- Have had tests that showed that angioplasty might help their angina.
This decision aid may also be helpful if you are scheduled to have an angiogram. Depending on what that test finds, an angioplasty can sometimes be done at the same time.
Key points to remember
- Both medical therapy alone (heart-healthy lifestyle and taking medicines) and angioplasty plus medical therapy can relieve angina.
- Angioplasty may relieve your symptoms sooner. But if you can stand to live with your symptoms for a while, medicines and healthy changes may give you about the same relief as angioplasty.
- Angioplasty has a risk of heart attack, stroke, and death. But these rarely happen.
- Angioplasty will not cure heart disease, prevent a heart attack, or help you live longer. Most heart attacks are caused by small plaques that break open and cause a clot, not by large plaques that slow blood flow and cause angina symptoms.
- Whichever treatment you choose, you will still need to take medicines and have a healthy lifestyle. 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.
FAQsWhat is angioplasty?
Angioplasty is a procedure to restore blood flow in narrowed coronary arteries, Opens dialog.
During angioplasty, Opens dialog, 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, Opens dialog 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 may go home the same day. Or you may stay at least 1 night in the hospital. After you leave the hospital, you will avoid strenuous activity and not lift anything heavy until your doctor says it is okay. This may be for several days.
Treatment after angioplasty
It's important to continue medical therapy. This includes having a heart-healthy lifestyle and taking medicines to prevent a heart attack and stroke.
If you get a stent, you may 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 may take both medicines for at least 6 months. If your stent is bare metal, you may take both medicines for at least 1 month. After that, you will likely keep taking one of the medicines.
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.
To have a heart-healthy lifestyle, be active, eat healthy foods, stay at a healthy weight, manage other health problems, and don't smoke.
What is medical therapy for stable angina?
Medical therapy includes taking medicines and having a heart-healthy lifestyle. Medical therapy is important for all people who have coronary artery disease. Whatever choice you make about angioplasty, medical therapy will give you the best chance of keeping coronary artery 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 take medicine to relieve angina symptoms. Examples of angina medicines include nitroglycerin, beta-blockers, and calcium channel blockers.
Heart-healthy lifestyle
A heart-healthy lifestyle includes eating a healthy diet, not smoking, staying at a healthy weight, and getting daily exercise.
Your doctor may 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. These foods include vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. Limit things that are not so good for your heart, like sodium, alcohol, and sugar.
- Stay at a healthy weight. Lose weight if you need to.
- Manage other health problems, including diabetes, high blood pressure, and high cholesterol.
After angioplasty, a cardiac rehab program can help you make lifestyle changes if you need to. Talk to your doctor about whether rehab is right for you. Cardiac rehab includes supervised exercise. It also includes help with diet and lifestyle changes and emotional support.
Why might you have angioplasty?
You may have had tests such as an exercise stress test or a coronary angiogram, Opens dialog 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, Opens dialog. (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:footnote 7
- 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 can also improve your quality of life. If your symptoms happen a lot, you are more likely to have a better quality of life after the procedure.footnote 10
Angioplasty 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 2
- It does not prevent a heart attack.
- It does not help you live longer.
It may be hard to understand why angioplasty does not lower your risk of a heart attack or help you live longer. It's because of how coronary artery disease and plaque, Opens dialog 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 and a heart-healthy lifestyle.
What are the risks of angioplasty?
Angioplasty has some risks. They include:
- The need for emergency bypass, Opens dialog surgery during the procedure.
- Heart attack.
- Stroke.
- Death.
Your doctor can help you know your chance of problems from the procedure. Several things, including age and health, can raise your risk of problems. For example, older people or those with heart failure, Opens dialog or kidney disease have a higher risk of problems.
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 to decide whether or not to have 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 treatmentfootnote 13 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
*These numbers are based on one research study.footnote 13Another study showed a similar trend in symptom relief after angioplasty.footnote 10footnote 9(Evidence quality: moderate, Opens dialog.)
Both medical therapy alone (heart-healthy lifestyle and taking medicines) and angioplasty plus medical therapy can relieve angina. Angioplasty improves angina sooner. But over time, both treatments may work about the same to ease symptoms and improve quality of life.footnote 13footnote 10
Take 100 people who had angioplasty in one study, Opens dialog:footnote 13
- 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.
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.
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.
Risks
The following numbers about risks come from problems seen in patients in hospitals.
Take 100 people who have angioplasty, Opens dialog. They have the following risks:
Examples of angioplasty risks* Possible problems from the procedure How many people had this problem Damage to the blood vessel where catheter is put infootnote 11, footnote 4 About 1 to 4out of 100 Bleeding problem during the procedurefootnote 8 About 1 or 2 out of 100 Emergency bypass surgeryfootnote 6 Fewer than 1 out of 100 people (4 out of 1,000) Strokefootnote 1 Fewer than 1 out of 100 (2 out of 1,000) Death in the hospitalfootnote 12 Fewer than 1 out of 100 (1 out of 1,000)
*Based on rates of complications from patients.
What is angioplasty?
Angioplasty is a procedure to restore blood flow in narrowed coronary arteries, Opens dialog.
During angioplasty, Opens dialog, 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, Opens dialog 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 may go home the same day. Or you may stay at least 1 night in the hospital. After you leave the hospital, you will avoid strenuous activity and not lift anything heavy until your doctor says it is okay. This may be for several days.
Treatment after angioplasty
It's important to continue medical therapy. This includes having a heart-healthy lifestyle and taking medicines to prevent a heart attack and stroke.
If you get a stent, you may 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 may take both medicines for at least 6 months. If your stent is bare metal, you may take both medicines for at least 1 month. After that, you will likely keep taking one of the medicines.
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.
To have a heart-healthy lifestyle, be active, eat healthy foods, stay at a healthy weight, manage other health problems, and don't smoke.
What is medical therapy for stable angina?
Medical therapy includes taking medicines and having a heart-healthy lifestyle. Medical therapy is important for all people who have coronary artery disease. Whatever choice you make about angioplasty, medical therapy will give you the best chance of keeping coronary artery 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 take medicine to relieve angina symptoms. Examples of angina medicines include nitroglycerin, beta-blockers, and calcium channel blockers.
Heart-healthy lifestyle
A heart-healthy lifestyle includes eating a healthy diet, not smoking, staying at a healthy weight, and getting daily exercise.
Your doctor may 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. These foods include vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. Limit things that are not so good for your heart, like sodium, alcohol, and sugar.
- Stay at a healthy weight. Lose weight if you need to.
- Manage other health problems, including diabetes, high blood pressure, and high cholesterol.
After angioplasty, a cardiac rehab program can help you make lifestyle changes if you need to. Talk to your doctor about whether rehab is right for you. Cardiac rehab includes supervised exercise. It also includes help with diet and lifestyle changes and emotional support.
Why might you have angioplasty?
You may have had tests such as an exercise stress test or a coronary angiogram, Opens dialog 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, Opens dialog. (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:footnote 7
- 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 can also improve your quality of life. If your symptoms happen a lot, you are more likely to have a better quality of life after the procedure.footnote 10
Angioplasty 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 2
- It does not prevent a heart attack.
- It does not help you live longer.
It may be hard to understand why angioplasty does not lower your risk of a heart attack or help you live longer. It's because of how coronary artery disease and plaque, Opens dialog 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 and a heart-healthy lifestyle.
What are the risks of angioplasty?
Angioplasty has some risks. They include:
- The need for emergency bypass, Opens dialog surgery during the procedure.
- Heart attack.
- Stroke.
- Death.
Your doctor can help you know your chance of problems from the procedure. Several things, including age and health, can raise your risk of problems. For example, older people or those with heart failure, Opens dialog or kidney disease have a higher risk of problems.
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 to decide whether or not to have 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
| | 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 |
*These numbers are based on one research study.footnote 13Another study showed a similar trend in symptom relief after angioplasty.footnote 10footnote 9(Evidence quality: moderate, Opens dialog.)
Both medical therapy alone (heart-healthy lifestyle and taking medicines) and angioplasty plus medical therapy can relieve angina. Angioplasty improves angina sooner. But over time, both treatments may work about the same to ease symptoms and improve quality of life.footnote 13footnote 10
Take 100 people who had angioplasty in one study, Opens dialog:footnote 13
- 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.
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.
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.
Risks
The following numbers about risks come from problems seen in patients in hospitals.
Take 100 people who have angioplasty, Opens dialog. They have the following risks:
| Possible problems from the procedure | How many people had this problem |
|---|---|
| Damage to the blood vessel where catheter is put infootnote 11, footnote 4 | About 1 to 4out of 100 |
| Bleeding problem during the procedurefootnote 8 | About 1 or 2 out of 100 |
| Emergency bypass surgeryfootnote 6 | Fewer than 1 out of 100 people (4 out of 1,000) |
| Strokefootnote 1 | Fewer than 1 out of 100 (2 out of 1,000) |
| Death in the hospitalfootnote 12 | Fewer than 1 out of 100 (1 out of 1,000) |
*Based on rates of complications from patients.
Compare your options
| Have angioplasty, along with taking medicines and having a healthy lifestyle | Take medicines and have a heart-healthy lifestyle (medical therapy) | |
|---|---|---|
| What is usually involved? |
|
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| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Compare
What is usually involved? | ||
|---|---|---|
What are the benefits? | ||
What are the risks and side effects? |
- You may go home the same day. Or you may stay at least 1 night in the hospital. 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, Opens dialog, you will take aspirin and another medicine to prevent blood clots.
- You have a healthy lifestyle. This includes exercising, eating heart-healthy food, staying at a healthy weight, and not smoking.
- You manage other health problems, including diabetes, high blood pressure, and high cholesterol.
- Angioplasty can relieve angina.
- Angioplasty can improve your quality of life.
- 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 have a healthy lifestyle. This includes exercising, eating heart-healthy food, staying at a healthy weight, and not 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 taking medicines to relieve angina. These include headaches and lightheadedness.
- 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.
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'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
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 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
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.
Each pair of questions uses a 3 point scale where 3 is more important, 1 is less important and 0 is equally important. Use the right and left arrow keys to navigate the scale.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.
I would rather take less medicine for angina.
I don't mind taking medicine for angina.
I'm not worried about the risks of angioplasty.
I'm worried about the risks of angioplasty.
My other important reasons:
My other important reasons:
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.
Use the following 3 point scale where 3 is leaning toward, 1 is may be leaning toward, and 0 is undecided. Use the right and left arrow keys to navigate the scale.Angioplasty
Medical therapy
What else do you need to make your decision?
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 | Ignite Healthwise, LLC Staff |
|---|---|
| Clinical Review Board | Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
References
Citations
- Aggarwal A, et al (2009). Incidence and predictors of stroke associated with percutaneous coronary intervention. American Journal of Cardiology, 104 (3): 349-53. DOI: 10.1016/j.amjcard.2009.03.046. Accessed March 23, 2017.
- Bangalore S, et al. (2020). Routine revascularization versus initial medical therapy for stable ischemic heart disease: A systematic review and meta-analysis of randomized trials. Circulation, published online June 26, 2020. DOI: 10.1161/CIRCULATIONAHA.120.048194. Accessed June 26, 2020.
- 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.
- Bernat I, et al. (2019) Best practices for the prevention of radial artery occlusion after transradial diagnostic angiography and intervention: An international consensus paper. Journal of the American College of Cardiology: Cardiovascular Interventions, 12(22): 2235–2246. DOI: 10.1016/j.jcin.2019.07.043. Accessed July 6, 2020.
- 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.
- Kutcher MA, et al. (2009). Percutaneous coronary interventions in facilities without cardiac surgery on site: A report from the National Cardiovascular Data Registry (NCDR). Journal of the American College of Cardiology, 54(1): 16–24. DOI: 10.1016/j.jacc.2009.03.038. Accessed March 23, 2017.
- Lawton JS, et al. (2022). 2021 ACC/AHA/SCAI Guideline for coronary artery revascularization: A report from the American College of Cardiology/American Heart Association. Journal of the American College of Cardiology, 79(2): e21–e129. DOI: 10.1016/j.jacc.2021.09.006. Accessed December 9, 2021.
- Lichtman JH, et al. (2014). Age and sex differences in inhospital complications rates and mortality after percutaneous coronary intervention procedures: Evidence from the NCDR. American Heart Journal, 167(3): 376-83. DOI: 10.1016/j.ahj.2013.11.001. Accessed March 23, 2017.
- Maron DJ, et al. (2020). Initial invasive or conservative strategy for stable coronary disease. New England Journal of Medicine, 382(15): 1395–1407. DOI: 10.1056/NEJMoa1915925. Accessed April 2, 2020.
- Spertus JA, et al. (2020). Health status after invasive or conservative care in coronary and advanced kidney disease. The New England Journal of Medicine, 382(17): 1619–1628. DOI: 10.1056/NEJMoa1916374. Accessed April 2, 2020.
- 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.
- Vora AN, et al. (2016). Temporal trends in the risk profile of patients undergoing outpatient percutaneous coronary intervention. Circulation Cardiovascular Interventions, 9(3): e003070. DOI: 10.1161/CIRCINTERVENTIONS.115.003070. Accessed March 23, 2017.
- 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.
Coronary Artery Disease: Should I Have Angioplasty for Stable Angina?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- 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 having a heart-healthy lifestyle.
- Take medicines and have a heart-healthy lifestyle to treat stable angina. This is called medical therapy.
This decision aid is for people who:
- Have stable angina. This means you can usually predict when your symptoms will happen.
- Have already tried medicines for angina symptoms.
- Have had tests that showed that angioplasty might help their angina.
This decision aid may also be helpful if you are scheduled to have an angiogram. Depending on what that test finds, an angioplasty can sometimes be done at the same time.
Key points to remember
- Both medical therapy alone (heart-healthy lifestyle and taking medicines) and angioplasty plus medical therapy can relieve angina.
- Angioplasty may relieve your symptoms sooner. But if you can stand to live with your symptoms for a while, medicines and healthy changes may give you about the same relief as angioplasty.
- Angioplasty has a risk of heart attack, stroke, and death. But these rarely happen.
- Angioplasty will not cure heart disease, prevent a heart attack, or help you live longer. Most heart attacks are caused by small plaques that break open and cause a clot, not by large plaques that slow blood flow and cause angina symptoms.
- Whichever treatment you choose, you will still need to take medicines and have a healthy lifestyle. 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.
What is angioplasty?
Angioplasty is a procedure to restore blood flow in narrowed coronary arteries, Opens dialog.
During angioplasty, Opens dialog, 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, Opens dialog 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 may go home the same day. Or you may stay at least 1 night in the hospital. After you leave the hospital, you will avoid strenuous activity and not lift anything heavy until your doctor says it is okay. This may be for several days.
Treatment after angioplasty
It's important to continue medical therapy. This includes having a heart-healthy lifestyle and taking medicines to prevent a heart attack and stroke.
If you get a stent, you may 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 may take both medicines for at least 6 months. If your stent is bare metal, you may take both medicines for at least 1 month. After that, you will likely keep taking one of the medicines.
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.
To have a heart-healthy lifestyle, be active, eat healthy foods, stay at a healthy weight, manage other health problems, and don't smoke.
What is medical therapy for stable angina?
Medical therapy includes taking medicines and having a heart-healthy lifestyle. Medical therapy is important for all people who have coronary artery disease. Whatever choice you make about angioplasty, medical therapy will give you the best chance of keeping coronary artery 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 take medicine to relieve angina symptoms. Examples of angina medicines include nitroglycerin, beta-blockers, and calcium channel blockers.
Heart-healthy lifestyle
A heart-healthy lifestyle includes eating a healthy diet, not smoking, staying at a healthy weight, and getting daily exercise.
Your doctor may 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. These foods include vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. Limit things that are not so good for your heart, like sodium, alcohol, and sugar.
- Stay at a healthy weight. Lose weight if you need to.
- Manage other health problems, including diabetes, high blood pressure, and high cholesterol.
After angioplasty, a cardiac rehab program can help you make lifestyle changes if you need to. Talk to your doctor about whether rehab is right for you. Cardiac rehab includes supervised exercise. It also includes help with diet and lifestyle changes and emotional support.
Why might you have angioplasty?
You may have had tests such as an exercise stress test or a coronary angiogram, Opens dialog 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, Opens dialog. (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:7
- 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 can also improve your quality of life. If your symptoms happen a lot, you are more likely to have a better quality of life after the procedure.10
Angioplasty 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:2
- It does not prevent a heart attack.
- It does not help you live longer.
It may be hard to understand why angioplasty does not lower your risk of a heart attack or help you live longer. It's because of how coronary artery disease and plaque, Opens dialog 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 and a heart-healthy lifestyle.
What are the risks of angioplasty?
Angioplasty has some risks. They include:
- The need for emergency bypass, Opens dialog surgery during the procedure.
- Heart attack.
- Stroke.
- Death.
Your doctor can help you know your chance of problems from the procedure. Several things, including age and health, can raise your risk of problems. For example, older people or those with heart failure, Opens dialog or kidney disease have a higher risk of problems.
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 to decide whether or not to have 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
| | 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 |
*These numbers are based on one research study.13Another study showed a similar trend in symptom relief after angioplasty.109(Evidence quality: moderate, Opens dialog.)
Both medical therapy alone (heart-healthy lifestyle and taking medicines) and angioplasty plus medical therapy can relieve angina. Angioplasty improves angina sooner. But over time, both treatments may work about the same to ease symptoms and improve quality of life.1310
Take 100 people who had angioplasty in one study, Opens dialog:13
- 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.
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.
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.
Risks
The following numbers about risks come from problems seen in patients in hospitals.
Take 100 people who have angioplasty, Opens dialog. They have the following risks:
| Possible problems from the procedure | How many people had this problem |
|---|---|
| Damage to the blood vessel where catheter is put infootnote 11, footnote 4 | About 1 to 4out of 100 |
| Bleeding problem during the procedurefootnote 8 | About 1 or 2 out of 100 |
| Emergency bypass surgeryfootnote 6 | Fewer than 1 out of 100 people (4 out of 1,000) |
| Strokefootnote 1 | Fewer than 1 out of 100 (2 out of 1,000) |
| Death in the hospitalfootnote 12 | Fewer than 1 out of 100 (1 out of 1,000) |
*Based on rates of complications from patients.
2. Compare your options
| Have angioplasty, along with taking medicines and having a healthy lifestyle | Take medicines and have a heart-healthy lifestyle (medical therapy) | |
|---|---|---|
| What is usually involved? |
|
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| What are the benefits? |
|
|
| What are the risks and side effects? |
|
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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.
I would rather take less medicine for angina.
I don't mind taking medicine for angina.
I'm not worried about the risks of angioplasty.
I'm worried about the risks of angioplasty.
My other important reasons:
My other important reasons:
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
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
2. If you keep trying medical therapy now, can you still have angioplasty later?
- Yes
- No
- I'm not sure
3. Does angioplasty have serious risks?
- Yes
- No
- I'm not sure
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?
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.
| By | Ignite Healthwise, LLC Staff |
|---|---|
| Clinical Review Board | Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
- Aggarwal A, et al (2009). Incidence and predictors of stroke associated with percutaneous coronary intervention. American Journal of Cardiology, 104 (3): 349-53. DOI: 10.1016/j.amjcard.2009.03.046. Accessed March 23, 2017.
- Bangalore S, et al. (2020). Routine revascularization versus initial medical therapy for stable ischemic heart disease: A systematic review and meta-analysis of randomized trials. Circulation, published online June 26, 2020. DOI: 10.1161/CIRCULATIONAHA.120.048194. Accessed June 26, 2020.
- 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.
- Bernat I, et al. (2019) Best practices for the prevention of radial artery occlusion after transradial diagnostic angiography and intervention: An international consensus paper. Journal of the American College of Cardiology: Cardiovascular Interventions, 12(22): 2235–2246. DOI: 10.1016/j.jcin.2019.07.043. Accessed July 6, 2020.
- 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.
- Kutcher MA, et al. (2009). Percutaneous coronary interventions in facilities without cardiac surgery on site: A report from the National Cardiovascular Data Registry (NCDR). Journal of the American College of Cardiology, 54(1): 16–24. DOI: 10.1016/j.jacc.2009.03.038. Accessed March 23, 2017.
- Lawton JS, et al. (2022). 2021 ACC/AHA/SCAI Guideline for coronary artery revascularization: A report from the American College of Cardiology/American Heart Association. Journal of the American College of Cardiology, 79(2): e21–e129. DOI: 10.1016/j.jacc.2021.09.006. Accessed December 9, 2021.
- Lichtman JH, et al. (2014). Age and sex differences in inhospital complications rates and mortality after percutaneous coronary intervention procedures: Evidence from the NCDR. American Heart Journal, 167(3): 376-83. DOI: 10.1016/j.ahj.2013.11.001. Accessed March 23, 2017.
- Maron DJ, et al. (2020). Initial invasive or conservative strategy for stable coronary disease. New England Journal of Medicine, 382(15): 1395–1407. DOI: 10.1056/NEJMoa1915925. Accessed April 2, 2020.
- Spertus JA, et al. (2020). Health status after invasive or conservative care in coronary and advanced kidney disease. The New England Journal of Medicine, 382(17): 1619–1628. DOI: 10.1056/NEJMoa1916374. Accessed April 2, 2020.
- 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.
- Vora AN, et al. (2016). Temporal trends in the risk profile of patients undergoing outpatient percutaneous coronary intervention. Circulation Cardiovascular Interventions, 9(3): e003070. DOI: 10.1161/CIRCINTERVENTIONS.115.003070. Accessed March 23, 2017.
- 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.
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Current as of: July 31, 2024
Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.