Surgery

When, in spite of lifestyle changes and optimal medical treatment, there is little effect on the severity of angina (demonstrated by failure on Bruce Protocol testing or limited exercise tolerance), or if testing suggests a high risk of a heart attack, angioplasty (PTCA) or coronary artery bypass grafting (CABG) should be considered as the best option.

Angioplasty and CABG differ in that angioplasty is a more minor procedure whereas CABG is a major operation which involves opening the chest wall, a longer recovery time in hospital, and a much longer convalescence.

PTCA or CABG is likely to be carried out directly as a consequence of the number and importance of the coronary vessels involved, (i.e. even if the angina is only moderate, if the left main artery (anterior descending artery) is affected, if the LAD artery is one of two diseased vessels, or if all the 3 coronary vessels are affected, prognosis will be improved by these procedures.

PTCA with or without stenting is usually used for patients with one or 2 lesions, while CABG improved prognosis for those with coronary disease affecting the left main vessel, or 3 – vessel disease.