alternatives to surgery

Because the degree of coronary artery narrowing can vary, so can the severity of the disease and your symptoms.

Your doctor can tell you whether the narrowing needs to be treated with a procedure. If a procedure isn’t necessary at this stage, they may prescribe medications and lifestyle modifications. These may limit or even reverse the narrowing.

To make these decisions, a number of things need to be considered, including the severity of your symptoms, your tolerance for medications, your overall health, your lifestyle and which coronary arteries are involved.

Types of procedure

There are two procedures for treating narrowing of the coronary arteries, angioplasty and stents or coronary artery bypass surgery. Your cardiologist and surgeon will talk to you about the pros and cons of each.

They’ll also consider:

• The frequency, severity and duration of your chest pain
• The degree of coronary artery narrowing
• Your risk of future cardiac events.

Medications

Medications are effective in many people with stable heart disease where the symptoms are predictable. They include low-dose aspirin and drugs to lower cholesterol (statins).

Drugs such as beta-blockers and angiotensin-converting enzyme (ACE) inhibitors can reduce demand on your heart and improve symptoms.

Chest pain can be relieved with nitrate drugs.

Angioplasty and stents

Angioplasty is a procedure that opens up a narrowed coronary artery to improve blood flow to your heart. A stent is a tiny mesh tube that is placed inside the narrowed artery to keep it open. The coronary artery is accessed through an artery in the top of your arm or your groin. The two procedures are often performed together. As this isn’t invasive surgery, the recovery time is rapid and there is very little discomfort compared with coronary bypass graft surgery.

Reasons to choose coronary bypass graft surgery over stents

• When most of your coronary arteries are narrowed. If you have just one or two narrowed arteries, angioplasty and stenting is an alternative, but if more are narrowed, coronary artery bypass graft surgery is often recommended.
• The location of the blockage is another factor. A blockage in the left main coronary artery can have a high risk of death. This may be another reason for choosing a coronary artery bypass graft instead of angioplasty and stents.
• Younger age. Stenting tends to have a shorter ‘life span’ than coronary bypass graft surgery. Often stenting may be used as a strategy to delay surgery and then reduce the need for repeated chest operations.
• In people with diabetes who also have multiple affected arteries, coronary artery bypass graft surgery has been proven to have clear advantages over angioplasty and stents.

Be sure to consult your doctor about any heart-related symptoms or concerns. If you have unexplained chest pain or breathlessness, call 000 immediately.