If you are one of the estimated 9 million Americans with angina—chest pain resulting from narrowed coronary arteries — you and your doctor can choose from 3 treatment options:
- medical management
- angioplasty
- coronary artery bypass surgery
The decision depends on the type of angina you are experiencing and the severity of your coronary artery disease.
Most people with angina have chronic stable angina; for months or years, they have suffered chest pain predictably associated with a certain amount of physical activity or with emotional stress. A study published in an August issue of the New England Journal of Medicine found that, at the end of 3 years, the individuals who received optimal medical treatment, as described below, got the same amount of pain relief as those who underwent angioplasty.
These results raise questions about whether many of the more than 1 million angioplasties performed in the United States each year are really needed.
However, you still might elect angioplasty because the results in this study, and others, do show that angioplasty improves angina more rapidly than does medical therapy, and is particularly effective for severe anginal pain. In some cases, improvements with angioplasty can be superior to those accomplished with medical management and can last for as long as 6 to 24 months. So, angioplasty is probably the right choice if your angina is severe and frequent enough to interfere with your daily activities.
Angioplasty involves insertion of a small tube (catheter) with a deflated balloon at its tip into the femoral artery in the groin. The catheter is guided to the site of an atherosclerotic plaque that has narrowed a coronary artery. Repeated inflation of the balloon at the site compresses the plaque and widens the narrowed artery, allowing the blood to flow more easily. Most often, a tiny metal stent is implanted in that section of the vessel to keep the artery propped open.
Carried out in a cardiac catheterization laboratory, the angioplasty procedure takes 1 to 2 hours, does not require general anesthesia, and usually entails no more than an overnight stay in the hospital. Drugs, such as aspirin and Plavix, must be taken for 6 to 18 months afterwards to prevent formation of a blood clot due to the clumping of blood platelets at the site of the stent. Unfortunately, clots and overgrowth of tissue are not uncommon, and then another angioplasty must be done to reopen the artery.
It's also important to keep in mind that the NEJM study compared angioplasty with medical treatment that was optimal. Maximal benefit from medical management will require that you adopt proper lifestyle measures, like smoking cessation, proper diet, and exercise, as well as that you take medications if needed to control blood pressure and cholesterol levels.
Your doctor will probably recommend either angioplasty or bypass surgery if the build-up of coronary artery plaques threatens to cause a heart attack or if you develop unstable angina. Unstable angina is often described as a condition mid-way between stable angina and a heart attack. Unstable angina is characterized by
- pain while at rest
- chest pain that is more severe or lasts longer than prior episodes of angina
- chest pain not relieved by rest or medication
If you develop unstable angina, you must obtain immediate medical attention because a heart attack may follow shortly.
