My angina has grown steadily worse over the past three months despite what my cardiologist tells me is maximal drug treatment. She now recommends that I have either angioplasty or coronary artery bypass surgery. Could you give me some information that might help me to choose between these two procedures?
The choice between angioplasty and coronary artery bypass surgery depends on many factors unique to each individual. These factors include the extent and location of your coronary artery disease, the presence of other medical illnesses and your attitudes and lifestyle. The best candidates for angioplasty are those with involvement of only a single coronary artery close to the place where it enters the heart. An exception to this general rule is a narrowing of 50 percent or more in the left main coronary artery; in this situation bypass surgery is the proper approach.
Bypass surgery also is the preferred procedure whenever more than one coronary artery is occluded or severely narrowed. However, angioplasty may be preferable when several arteries are involved in patients with severe chronic lung disease or another medical condition that puts them at especially high risk for surgery.
Overall death rates of angioplasty and bypass surgery (1 percent to 2 percent) are similar, but the short-term risk of bypass surgery is greater than that of angioplasty in low-risk patients in good general health. On the other hand, within six months in about one third of angioplasty patients who have a good initial result, the reappearance of angina due to recurrent narrowing of the vessel will require repeat coronary angiography and either another angioplasty or bypass surgery.
In contrast, bypass surgery has been shown to generally provide good relief of angina for five years or more. You need to weigh your possible fear of the more extensive bypass procedure and the subsequent one to two months of disability against the fact that angioplasty entails a much greater likelihood that a second procedure will be required in a relatively short time.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.