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Coronary artery disease: your treatment options in India

Also called ischaemic or coronary heart disease. The arteries supplying the heart muscle narrow with fatty deposits, and the muscle stops getting enough blood — most noticeably when you exert yourself.

This page explains what the diagnosis means, what tests establish it, and how the choice between medication, a stent and bypass surgery is actually made. It is written for patients who have been given a diagnosis and are deciding what to do next.

Written and clinically reviewed by Dr. Annie Varughese, MD, FACC Last reviewed August 2026 Editorial and medical review policy
Main treatments
Three
Medication, angioplasty with a stent, or bypass surgery
Deciding test
Angiogram
The single document that determines the recommendation
Time in India
10 days to 4 weeks
Stent at the short end, bypass at the long end
Cost vs Europe or US
20–33%
Of the same procedure's price
On this page
  1. What coronary artery disease is
  2. Symptoms, and the ones that mean emergency
  3. How it is diagnosed
  4. Your three treatment options
  5. How the choice is actually made
  6. How urgent is your case
  7. What to send us
  8. Questions patients ask
The condition

What coronary artery disease is

Three main arteries sit on the surface of the heart and supply the muscle itself with blood. Over years, fatty plaque builds inside their walls and narrows them. While you are resting, a narrowed artery may still deliver enough blood. When you climb stairs or walk uphill, the muscle demands more, the narrowed artery cannot supply it, and you feel it as chest tightness or breathlessness. That is angina.

A heart attack is a different event. A plaque ruptures, a clot forms on top of it, and the artery blocks completely within minutes. The muscle downstream begins to die. This is why the distinction between stable symptoms and sudden ones matters so much, and why the warning at the top of this page is there.

The disease is a process rather than a single blockage. This is worth understanding before anyone offers you a procedure: a stent or a bypass restores blood flow past the narrowings you have now. Neither stops new ones forming. That is what the medication is for, and it is why you will still be taking tablets afterwards.

Symptoms

Symptoms, and the ones that mean emergency

Common symptoms
  • Chest tightness, pressure or heaviness on exertion
  • Pain spreading to the left arm, jaw, neck or back
  • Breathlessness climbing stairs or walking uphill
  • Symptoms that ease within minutes of stopping
  • Unusual fatigue on ordinary activity
  • In people with diabetes, breathlessness or fatigue without any chest pain at all
Warning signs of an emergency
  • Chest pain lasting more than a few minutes at rest
  • Pain with sweating, nausea or vomiting
  • Angina that is new, worsening, or occurring at lower and lower effort
  • Angina waking you at night
  • Sudden severe breathlessness
  • Fainting or near-fainting

These are not symptoms to research. They are symptoms to act on.

Any of the warning signs above means immediate assessment at your nearest hospital, in your own country, today. Medical travel is for planned treatment of stable disease. Nothing on this page should delay you by even an hour if that list describes you.

Diagnosis

How it is diagnosed

Four tests do most of the work. You may already have had some of them.

Initial tests

  • ECG — records the heart's electrical activity; may show damage from a previous heart attack
  • Blood tests — troponin for muscle damage, plus cholesterol and HbA1c for risk
  • Echocardiogram — ultrasound showing how well the muscle is pumping and which walls move poorly
  • Treadmill or stress test — looks for changes when the heart is worked

The deciding tests

  • CT coronary angiogram — non-invasive; good at ruling disease out
  • Coronary angiogram — a catheter and dye map the arteries directly. This is the test that shows exactly which vessels are narrowed and by how much
  • FFR or iFR — measures whether a specific narrowing is actually limiting blood flow

Why we ask for the angiogram first

Every recommendation on this page depends on which arteries are involved, where the narrowings sit, and how severe they are. Without the angiogram, anyone telling you whether you need a stent or bypass surgery is guessing — and if they are quoting you a price at the same time, guessing in their own favour. Send the report, and the images if you have them on a disc or in an app.

Options

Your three treatment options

These are not a ladder from mild to severe. They treat different patterns of disease, and one is not an upgrade on another.

Option one

Medication and risk factor control

Antiplatelet drugs, statins, beta blockers and blood pressure control, alongside diabetes management and stopping smoking. For many patients with stable symptoms and disease that is not critically narrowing a major vessel, this is not a lesser option — it is the correct one, and trials have repeatedly shown it performs as well as stenting for symptom control in that group.

Usually appropriate whenSymptoms are stable and controlled, and the angiogram does not show critical disease in the left main artery or in all three vessels.
Option two

Angioplasty with a stent

A catheter is passed from the wrist or groin to the narrowed artery, a balloon opens it, and a drug-eluting stent holds it open. No chest incision, one or two nights in hospital, and normal activity within days. You will need antiplatelet medication for a defined period afterwards, and stopping it early carries a real risk of the stent clotting.

Usually appropriate whenOne or two vessels are involved, the narrowings are accessible, and symptoms are not controlled by medication alone — or in the setting of acute coronary syndrome.
Option three

Coronary artery bypass grafting

Healthy vessels from the chest wall, leg or forearm are used to route blood around the blockages. It is a larger undertaking — the breastbone is opened, recovery takes weeks, and you will be in India for three to four. In return it deals with several vessels at once and, in specific patterns of disease, has shown better long-term survival than stenting.

Usually appropriate whenThree vessels are involved, the left main artery is significantly narrowed, the pumping function is reduced, or you have diabetes with multi-vessel disease.
The decision

How the choice is actually made

The anatomy decides most of it

How many vessels are diseased, whether the left main artery is involved, and whether the narrowings are technically approachable with a catheter. This is read off the angiogram, not from your symptoms.

Then your other conditions

Diabetes, kidney function, previous stroke, lung disease and age all shift the balance. Diabetes with disease in several vessels is the clearest example — it moves the recommendation towards surgery.

Then what you can live with

Lifelong antiplatelet drugs after a stent, or several weeks of recovery after bypass. Both are real costs, and where you live and what care you can access at home is part of that calculation.

Be cautious of any facility that recommends a procedure before seeing your angiogram, or that recommends the same procedure to everyone. Dr. Varughese reads your films herself and explains the reasoning in writing, including what a reasonable alternative would be.

Urgency

How urgent is your case

Usually safe to plan travel
  • Stable angina, unchanged for months
  • Symptoms only on significant exertion and relieved by rest
  • Disease found on a scan without troubling symptoms
  • You are already on medication and stable on it
Needs local assessment before travel
  • Angina getting worse over days or weeks
  • Chest pain at rest or at night
  • Significant left main artery disease
  • A recent heart attack within the past few weeks
  • Breathlessness at rest, or fainting

We will tell you which column you are in

If your reports put you in the right-hand column, we will say so and tell you to be seen where you are. We will not book a flight for a patient who should be in a local emergency department, and we have turned cases away for exactly this reason.

Next step

What to send us

Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.

Most useful

  • Coronary angiogram report, and the images if you have them
  • Echocardiogram report
  • Recent ECG
  • Discharge summary from any admission

Also helpful

  • Blood tests including HbA1c and lipid profile
  • Kidney function tests
  • A list of your current medicines and doses
  • Your age, weight and whether you smoke
Send my reports for review See published cost ranges
Questions

Questions patients ask

Neither is better in general — they suit different patterns of disease. Angioplasty with a stent is usually right for one or two narrowed arteries and has a recovery measured in days. Bypass surgery is generally stronger for disease in three vessels, for disease in the left main artery, and for many patients with diabetes. Your angiogram answers the question, which is why it is the first document we ask for.

That depends entirely on your pattern of disease and your symptoms. Stable angina that has been unchanged for months usually allows weeks to plan properly. Left main disease, or angina that is getting worse or occurring at rest, is a different situation and needs urgent local assessment rather than travel planning. Tell us which describes you and we will say so plainly.

Often, yes. Many patients with stable disease do well on medication — antiplatelets, statins, beta blockers — combined with blood pressure and diabetes control and stopping smoking. Stents and bypass relieve symptoms and, in specific patterns of disease, improve survival. They do not cure the underlying disease, and the medication continues afterwards either way.

The coronary angiogram report is the single most useful document, ideally with the images. Also useful: a recent ECG, echocardiogram report, blood tests including HbA1c and lipid profile, a list of your current medicines with doses, and any discharge summary from a previous admission. Photographs taken on your phone are fine.

In almost all cases, yes. Stents require antiplatelet medication for a defined period and usually aspirin indefinitely; statins are generally lifelong. Do not stop any of it because you feel well. Stopping antiplatelet medication early after a stent carries a serious risk.

It can, quite significantly. In patients with diabetes and disease in several vessels, bypass surgery has generally shown better long-term results than stenting. It is one of the specific things Dr. Varughese looks at when she reads your angiogram.

RelatedOn this site
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