Q: My wife has suffered from chest pain. A cardiologist made a diagnosis of angina due to coronary disease. He has recommended a coronary angiogram and then angioplasty if necessary. We would like to know the effectiveness and risks of angioplasty.
A: Angioplasty involves the passage of a tiny, uninflated balloon to the site of narrowing in the coronary artery. Once in place the balloon is inflated several times to flatten the fatty plaque inside the artery and let blood flow more freely.
About 90 percent of the time, angioplasty results in a significant widening of the artery and in improvement in symptoms.
Possible complications are a rip or total closure of the artery that may require emergency bypass surgery.
The major problem with angioplasty is that blockage of the treated vessel recurs in about a third of all patients within six months afterward, usually requiring another angioplasty or bypass surgery.
Studies reported in 1993, describing the results of angioplasties done at the Mayo Clinic and the National Heart, Lung and Blood Institute, found the risk of complications following angioplasty was much greater in women than in men.
At the Mayo Clinic, the mortality rate within the hospital was 5.7 percent for women compared with only 2.7 percent in men. One explanation is that the women were older and had more severe angina, and more often had diabetes, higher blood pressure and higher cholesterol levels than male counterparts. Another is they have smaller arteries than men, which are more readily damaged during the angioplasty procedure.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.