2 bypass or not 2 bypass

History - 53 yo Married male with CAD and PAD, stroke. Since 1999 7 coronary blockages in LAD and first diagonal. 4 stents, 1 MI. 7 occlusions in iliacs, Left to right femoral bypass, dual iliac bypass. Recently hospitalized with chest pain after an emotional and physical day. Angiogram showed right coronary 75% occluded and LAD and first diagonal 90%. Doctors decided restenting the left side was not an option due to location right at the junction of LAD and 1st diagonal. MRI stress showed blood flow was OK through areas. Doctors decided best course for now is to treat medically. (The consensus of 15 doctors was either CABG or treat with medicine) My concern is that no medications were changed. It seems to me the blockages are going to continue to grow on the existing meds resulting in another MI. I am continuing with my normal lifestyle (retired) and continue with mild chest discomfort - 2-3 out of ten daily. Nitro relieves the pain. Major symptom seems to be shortness of breath comes on easily, general tiredness and retaining of water around my waist. I see the cardiologist in November. While I would rather avoid CABG, and some studies have shown medication just as effective as surgery,  I'm not 100% convinced to wait until another heart attack. Is it better to have it now while I am relatively healthy and could survive/recuperate better?

[kenkeith]

I have a totally blocked LAD (over 5 years) and a 72% occluded ICX.  The LAD location developed collateral vessels that provide a natural bypass (angiogenesis), and RCA stented.  You may have developed collateral vessels evidenced with blood flow OK.

The usual protocol medication regimen is an ACE inhibitor for a reduction of afterload, beta blocker for slow heart rate and blood pressure, and cholesterol med.  I don't require a diuretic for any fliud retention.  It is plausible the chol med can/will slow or stop progression of any occlusion.  Medication works for me...I take a nitrate prior to working out in the gym.

If medication can't provide relief from pain, then intervention would be the best option.  If there is pain unrelieved with meds, that would indicate your heart muscle is not receiving enough blood/oxygen, and the lack of blood/oxygen can damage the heart muscle.