Angioplasty Versus Coronary Artery Bypass Graft Surgery

It is important to understand that the decision to have angioplasty or coronary artery bypass graft (CABG) surgery to treat coronary artery disease (CAD) depends on many different things.

For help on making a decision to have angioplasty or bypass surgery, see:

Heart Disease: Should I Have Angioplasty for Stable Angina?

Heart Disease: Should I Have Bypass Surgery?

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 is chest pain or discomfort that occurs only with emotional or physical stress and goes 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 may 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.

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.

Your chances of having a serious problem with this procedure increase with age.

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.

How do you know if you need bypass surgery?

Not everyone with coronary artery disease needs bypass surgery. Some people can be helped by angioplasty with stents . Others use medical therapy, which involves making lifestyle changes and taking medicines. Some people use both of those treatments. Your doctor is likely to recommend bypass surgery only if you will benefit from it and if those benefits are greater than the risks.

Your choice may depend on the number of arteries that are narrowed or blocked or which arteries are affected. Talk with your doctor about the best treatment for you. The best treatment for you may also depend on your age, your health, and how much your chest pain is affecting your quality of life.

What are the risks of bypass surgery?

Bypass surgery has been done for more than 40 years. But it has some serious risks.

The risks of bypass surgery include:

• Too much bleeding. This can lead to the need for a transfusion.
• Stroke.
• Heart attack.
• Death.

Other risks include return of angina, problems from anesthesia, and infections at the site of the chest incision. Some people also have memory loss and trouble thinking clearly. These problems are most common in older people and tend to improve several months after surgery.

Your chances of having a serious problem with bypass surgery increase with age. Your risk is also higher if you have other problems such as diabetes, kidney disease, lung disease, or peripheral arterial disease. It's important to talk with your doctor to find out how your health affects your risk.