Heart 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.
Heart 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.
Key points to remember
- Medical therapy (medicines and lifestyle changes) and angioplasty work about the same at preventing heart attacks and helping people live longer. There is no evidence to show that angioplasty for stable heart disease will help you live any longer than medical therapy. Also, angioplasty does not lower the risk of having a heart attack any more than medical therapy does.
- Angioplasty can relieve angina symptoms if medical therapy has not stopped your symptoms. This may help you have a more active life.
- If you choose angioplasty, you will still need to make lifestyle changes. This will give you the best chance for a longer, healthier life.
- Angioplasty carries the risk of heart attack, stroke, and even death. These rarely happen. But you may not want to take even the small risk of dying from the procedure if you have an equally small risk of dying without it.
- If you decide to try medical therapy now, you can still have angioplasty later if your angina symptoms bother you too much.
- The benefits of angioplasty may not last. The repaired artery can become blocked again over time. You may need another procedure.
Who has the option of choosing angioplasty?
Choosing a treatment may seem like a decision that your doctor should make. But you can take part in this important choice if:
- You have mild heart disease. This means that you do not have too much narrowing of the arteries that send blood and oxygen to your heart (coronary arteries). It also means that your risk of having a heart attack is not too high.
- You have stable angina. This means your angina symptoms, such as chest pain or discomfort, happen with emotional or physical stress and go away when you rest or after you take nitroglycerin.
Your doctor can tell you if you meet these conditions.
You will want to talk to your doctor about angioplasty before you have a coronary angiogram (also called cardiac catheterization). During that test, you will not be able to take part in the decision about angioplasty, because you will be sleepy from medicines. So before the test, talk with your doctor about what the test might show and what the doctor's options are in each case. You can tell the doctor in advance what you would prefer, based on the test results.
How is angioplasty done?
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 artery. He or she inflates a small balloon at the end of the tube. This widens the artery to allow blood to flow. The doctor may put a small, expandable tube called a stent in the artery to keep it open.
After angioplasty, you will need to follow a heart-healthy diet and get plenty of exercise. You will also need to quit smoking if you smoke. Taking your medicines is also important.
What are the risks of angioplasty?
Angioplasty has some rare but serious risks. They are:
- The need for emergency open-chest surgery during the procedure.
- Heart attack.
- Stroke.
- Death.
Keep in mind that the chances of having a serious problem with this procedure are higher if you are older than 70.
Less serious risks related to the catheter include:
- Pain, swelling, and tenderness at the catheter insertion site.
- Bruising or bleeding at the catheter site.
Most people recover from angioplasty fairly quickly. They usually go home after an overnight stay in the hospital. They can return to normal activities within a few days.
What is medical therapy for stable angina?
Medical therapy includes making lifestyle changes and taking medicines. Lifestyle changes play a big role in helping you live longer. They include eating a healthy diet, not smoking, and getting daily exercise. Changing your habits may not be easy, 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.
- Exercise almost every day. The American Heart Association suggests that you exercise for at least 30 minutes on all or most days of the week.
- Eat a heart-healthy diet. This includes lots of fruits and vegetables, whole grains, and lean protein. Try to eat fish at least 2 times a week.
- Know your numbers. Keep track of your blood pressure and cholesterol, and take your medicines to keep your numbers in a healthy range.
- Stay at a healthy weight.
- Keep your blood sugar in a target range if you have diabetes.
Whatever choice you make about angioplasty, making these lifestyle changes will give you the best chance of keeping heart disease from getting worse. These changes are important for all people who have heart disease.
Taking medicines every day is another key part of medical therapy. You may need to take:
- Medicines to improve cholesterol, such as statins.
- Beta-blockers to keep your heart from working too hard. The medicine slows the heart rate and lowers blood pressure. It can help relieve chest pain and may prevent it.
- ACE inhibitors to lower blood pressure and the risk of heart attack.
- Aspirin or other medicines to reduce the risk of blood clots and heart attacks.
- Nitrates, such as nitroglycerin, to stop chest pain.
What are the side effects of medicines for stable angina?
All medicines have side effects. Your doctor may lower the dose or give you another drug if side effects bother you.
- Statins: The most common side effects include muscle aches, an upset stomach, gas, constipation, belly pain or cramps, and feeling more tired than usual. In rare cases, statins can cause liver problems or muscle pain and damage.
- Beta-blockers: Side effects include dizziness and feeling more tired than usual.
- ACE inhibitors: Side effects include a dry cough, nausea, diarrhea, and swelling of the face and hands.
- Aspirin and other medicines to reduce the risk of blood clots: They can cause an upset stomach and bleeding.
- Nitrates: Normal, temporary side effects of nitroglycerin include a warm or flushed feeling, a headache, dizziness, or lightheadedness. You may also have a burning feeling under your tongue when you put the pill there.
Even if you choose to have angioplasty, you may need to take at least some of these medicines.
How well does each treatment work for stable angina?
Medical therapy and angioplasty can both relieve angina symptoms. They also can make it easier for you to exercise, which is a key part of keeping your heart healthy.
With angioplasty, you'll feel relief from your angina symptoms sooner. But over time, both treatments work the same to ease symptoms and improve quality of life.1
Many people try medical therapy first. But it doesn't always work. You may decide to have angioplasty if you still have symptoms and can't exercise even after you have taken medicines and made lifestyle changes.
Angioplasty can ease angina symptoms, but it has not been proved to help you live any longer than medical therapy does. Also, angioplasty does not lower the risk of having a heart attack any more than medical therapy does.2
Why might your doctor recommend angioplasty?
Your doctor may recommend angioplasty if:
- You have angina symptoms that keep you from exercising and enjoying your life.
- Medical therapy hasn't stopped your angina.
Compare your options
Compare
|
What is usually involved? |
|
|
|
What are the benefits? |
|
|
|
What are the risks and side effects? |
|
- You stay in the hospital for 1 to 2 days. You can start walking 12 to 24 hours after angioplasty.
- You take medicines to help prevent heart attack or stroke.
- If you get a stent, you will take aspirin and other antiplatelet medicine to prevent blood clots.
- You make lifestyle changes such as exercising, eating a heart-healthy diet, and quitting smoking.
- Angioplasty can relieve angina if medical therapy has not stopped your symptoms.
- Angioplasty can improve your quality of life and help you live longer. But there is no evidence that angioplasty for stable heart disease lowers your risk of a heart attack any better than medical therapy or that angioplasty will help you live any longer than medical therapy will.
- The benefits of angioplasty may not last. You may need another procedure.
- Angioplasty carries the risk of heart attack, stroke, death, and the risk of needing emergency open-chest surgery during the procedure.
- The chances of having a serious problem during angioplasty are higher if you are older than 70.
- Angioplasty will not help you live any longer than medical therapy will.
- You make lifestyle changes such as exercising, eating a heart-healthy diet, and quitting smoking.
- You keep track of your blood pressure and cholesterol, and you keep your blood sugar under control if you have diabetes.
- You take medicine every day, such as statins, beta-blockers, ACE inhibitors, aspirin, and nitrates.
- Medical therapy can relieve angina symptoms.
- Medical therapy can improve your quality of life and help you live longer. But medical therapy will not help you live any longer than angioplasty will.
- You avoid the risks of angioplasty.
- Side effects
of medicines can include:
- Upset stomach, gas, belly pain, cramps, or diarrhea.
- Dry cough, dizziness, headaches, and feeling tired.
- Medical therapy doesn't always work. You may decide that you need angioplasty if you still have angina and can't exercise.
- Medical therapy will not help you live any longer than angioplasty will.
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
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 once in a while. But it's not too bad. My doctor said my angina is mild. We talked about it, and we decided that I could try taking medicines and taking 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 is a good choice for me.
Margie, age 62
My doctor said I have one artery that is partly blocked. She said I don't need angioplasty right now. Taking medicines and having a healthy lifestyle can prevent a heart attack or stroke. The first thing I have to do is quit smoking. I smoke a few cigarettes a day, but even a few is too many. So I will join a stop-smoking program and keep up with my diet and exercise.
Susan, age 56
I've had angina for a while now. I usually take nitroglycerin for it. 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 bother me and keep me from exercising and enjoying my life.
My angina doesn't bother me too much.
I'm concerned about side effects from the medicines in medical therapy.
I'm not worried about the side effects of medicines.
I think angioplasty will help me feel better faster.
I know I can have angioplasty later, so I want to try medical therapy first.
For me, the benefits of angioplasty outweigh the risks.
I want to avoid the risks of angioplasty if possible.
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.
Angioplasty
Medical therapy
What else do you need to make your decision?
Check the facts
Do you still have to make lifestyle changes if you have angioplasty?
- YesYou're right. If you choose angioplasty, you will still need to make lifestyle changes such as exercising, eating a heart-healthy diet, and quitting smoking.
- NoSorry, that's not right. If you choose angioplasty, you will still need to make lifestyle changes such as exercising, eating a heart-healthy diet, and quitting smoking.
- I'm not sureIt may help to go back and read "How is angioplasty done?" If you choose angioplasty, you will still need to make lifestyle changes such as exercising, eating a heart-healthy diet, and quitting smoking.
If you try medical therapy now, can you still have angioplasty later?
- YesYou're right. If you decide to try medical therapy now, you can still have angioplasty later if your angina symptoms bother you too much.
- NoSorry, that's not right. If you decide to try medical therapy now, you can still have angioplasty later if your angina symptoms bother you too much.
- I'm not sureIt may help to go back and read "How well does each treatment work for stable angina?" If you decide to try medical therapy now, you can still have angioplasty later if your angina symptoms bother you too much.
Does angioplasty have serious risks?
- YesYou're right. Angioplasty carries the rare risk of heart attack, stroke, and death. Your chances of having a serious problem are higher if you are older than 70.
- NoSorry, that's not right. Angioplasty carries the rare risk of heart attack, stroke, and death. Your chances of having a serious problem are higher if you are older than 70.
- I'm not sureIt may help to go back and read "What are the risks of angioplasty?" Angioplasty carries the rare risk of heart attack, stroke, and death. Your chances of having a serious problem are higher if you are older than 70.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
Certainty
How sure do you feel right now about your decision?
Check what you need to do before you make this decision.
Use the following space to list questions, concerns, and next steps.
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 | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology |
| Specialist Medical Reviewer | Robert A. Kloner, MD, PhD - Cardiology |
- 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.
- 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.
Heart 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 making healthy lifestyle changes.
- Take medicines and make lifestyle changes to treat stable angina. This is called medical therapy.
Key points to remember
- Medical therapy (medicines and lifestyle changes) and angioplasty work about the same at preventing heart attacks and helping people live longer. There is no evidence to show that angioplasty for stable heart disease will help you live any longer than medical therapy. Also, angioplasty does not lower the risk of having a heart attack any more than medical therapy does.
- Angioplasty can relieve angina symptoms if medical therapy has not stopped your symptoms. This may help you have a more active life.
- If you choose angioplasty, you will still need to make lifestyle changes. This will give you the best chance for a longer, healthier life.
- Angioplasty carries the risk of heart attack, stroke, and even death. These rarely happen. But you may not want to take even the small risk of dying from the procedure if you have an equally small risk of dying without it.
- If you decide to try medical therapy now, you can still have angioplasty later if your angina symptoms bother you too much.
- The benefits of angioplasty may not last. The repaired artery can become blocked again over time. You may need another procedure.
Who has the option of choosing angioplasty?
Choosing a treatment may seem like a decision that your doctor should make. But you can take part in this important choice if:
- You have mild heart disease. This means that you do not have too much narrowing of the arteries that send blood and oxygen to your heart (coronary arteries). It also means that your risk of having a heart attack is not too high.
- You have stable angina. This means your angina symptoms, such as chest pain or discomfort, happen with emotional or physical stress and go away when you rest or after you take nitroglycerin.
Your doctor can tell you if you meet these conditions.
You will want to talk to your doctor about angioplasty before you have a coronary angiogram (also called cardiac catheterization). During that test, you will not be able to take part in the decision about angioplasty, because you will be sleepy from medicines. So before the test, talk with your doctor about what the test might show and what the doctor's options are in each case. You can tell the doctor in advance what you would prefer, based on the test results.
How is angioplasty done?
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 artery. He or she inflates a small balloon at the end of the tube. This widens the artery to allow blood to flow. The doctor may put a small, expandable tube called a stent in the artery to keep it open.
After angioplasty, you will need to follow a heart-healthy diet and get plenty of exercise. You will also need to quit smoking if you smoke. Taking your medicines is also important.
What are the risks of angioplasty?
Angioplasty has some rare but serious risks. They are:
- The need for emergency open-chest surgery during the procedure.
- Heart attack.
- Stroke.
- Death.
Keep in mind that the chances of having a serious problem with this procedure are higher if you are older than 70.
Less serious risks related to the catheter include:
- Pain, swelling, and tenderness at the catheter insertion site.
- Bruising or bleeding at the catheter site.
Most people recover from angioplasty fairly quickly. They usually go home after an overnight stay in the hospital. They can return to normal activities within a few days.
What is medical therapy for stable angina?
Medical therapy includes making lifestyle changes and taking medicines. Lifestyle changes play a big role in helping you live longer. They include eating a healthy diet, not smoking, and getting daily exercise. Changing your habits may not be easy, 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.
- Exercise almost every day. The American Heart Association suggests that you exercise for at least 30 minutes on all or most days of the week.
- Eat a heart-healthy diet. This includes lots of fruits and vegetables, whole grains, and lean protein. Try to eat fish at least 2 times a week.
- Know your numbers. Keep track of your blood pressure and cholesterol, and take your medicines to keep your numbers in a healthy range.
- Stay at a healthy weight.
- Keep your blood sugar in a target range if you have diabetes.
Whatever choice you make about angioplasty, making these lifestyle changes will give you the best chance of keeping heart disease from getting worse. These changes are important for all people who have heart disease.
Taking medicines every day is another key part of medical therapy. You may need to take:
- Medicines to improve cholesterol, such as statins.
- Beta-blockers to keep your heart from working too hard. The medicine slows the heart rate and lowers blood pressure. It can help relieve chest pain and may prevent it.
- ACE inhibitors to lower blood pressure and the risk of heart attack.
- Aspirin or other medicines to reduce the risk of blood clots and heart attacks.
- Nitrates, such as nitroglycerin, to stop chest pain.
What are the side effects of medicines for stable angina?
All medicines have side effects. Your doctor may lower the dose or give you another drug if side effects bother you.
- Statins: The most common side effects include muscle aches, an upset stomach, gas, constipation, belly pain or cramps, and feeling more tired than usual. In rare cases, statins can cause liver problems or muscle pain and damage.
- Beta-blockers: Side effects include dizziness and feeling more tired than usual.
- ACE inhibitors: Side effects include a dry cough, nausea, diarrhea, and swelling of the face and hands.
- Aspirin and other medicines to reduce the risk of blood clots: They can cause an upset stomach and bleeding.
- Nitrates: Normal, temporary side effects of nitroglycerin include a warm or flushed feeling, a headache, dizziness, or lightheadedness. You may also have a burning feeling under your tongue when you put the pill there.
Even if you choose to have angioplasty, you may need to take at least some of these medicines.
How well does each treatment work for stable angina?
Medical therapy and angioplasty can both relieve angina symptoms. They also can make it easier for you to exercise, which is a key part of keeping your heart healthy.
With angioplasty, you'll feel relief from your angina symptoms sooner. But over time, both treatments work the same to ease symptoms and improve quality of life.1
Many people try medical therapy first. But it doesn't always work. You may decide to have angioplasty if you still have symptoms and can't exercise even after you have taken medicines and made lifestyle changes.
Angioplasty can ease angina symptoms, but it has not been proved to help you live any longer than medical therapy does. Also, angioplasty does not lower the risk of having a heart attack any more than medical therapy does.2
Why might your doctor recommend angioplasty?
Your doctor may recommend angioplasty if:
- You have angina symptoms that keep you from exercising and enjoying your life.
- Medical therapy hasn't stopped your angina.
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? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
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 once in a while. But it's not too bad. My doctor said my angina is mild. We talked about it, and we decided that I could try taking medicines and taking 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 is a good choice for me."
— Margie, age 62
"My doctor said I have one artery that is partly blocked. She said I don't need angioplasty right now. Taking medicines and having a healthy lifestyle can prevent a heart attack or stroke. The first thing I have to do is quit smoking. I smoke a few cigarettes a day, but even a few is too many. So I will join a stop-smoking program and keep up with my diet and exercise."
— Susan, age 56
"I've had angina for a while now. I usually take nitroglycerin for it. 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 bother me and keep me from exercising and enjoying my life.
My angina doesn't bother me too much.
I'm concerned about side effects from the medicines in medical therapy.
I'm not worried about the side effects of medicines.
I think angioplasty will help me feel better faster.
I know I can have angioplasty later, so I want to try medical therapy first.
For me, the benefits of angioplasty outweigh the risks.
I want to avoid the risks of angioplasty if possible.
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 make lifestyle changes if you have angioplasty?
- Yes
- No
- I'm not sure
2. If you try 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.
3. Use the following space to list questions, concerns, and next steps.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology |
| Specialist Medical Reviewer | Robert A. Kloner, MD, PhD - Cardiology |
- 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.
- 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.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Last Revised: April 6, 2012
Author: Healthwise Staff
Medical Review: Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & Robert A. Kloner, MD, PhD - Cardiology
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