Coronary artery disease can be treated many ways. The choice of treatment depends on the severity of the disease. Treatments include lifestyle changes and drug therapy, percutaneous transluminal coronary angioplasty, and coronary artery bypass surgery. Coronary artery disease is a chronic disease requiring lifelong care. Angioplasty or bypass surgery is not a cure.

People with less severe coronary artery disease may gain adequate control through lifestyle changes and drug therapy. Many of the lifestyle changes that prevent disease progression--a low-fat, low-cholesterol diet, weight loss if needed, exercise, and not smoking--also help prevent the disease from developing.

Drugs such as nitrates, beta-blockers, and calcium-channel blockers relieve chest pain and complications of coronary artery disease, but they cannot clear blocked arteries. Nitrates (nitroglycerin) improve blood flow to the heart. Beta-blockers (acebutelol, propranolol) reduce the amount of oxygen required by the heart during stress. One type of calcium-channel blocker (verapamil, diltiazem hydrochloride) helps keep the arteries open and reduces blood pressure. Aspirin helps prevent blood clots from forming on plaques, reducing the likelihood of a heart attack. Cholesterol-lowering medications are also indicated in most cases.

Percutaneous transluminal coronary angioplasty and bypass surgery are procedures that enter the body (invasive procedures) to improve blood flow in the coronary arteries. Percutaneous transluminal coronary angioplasty, usually called coronary angioplasty, is a non-surgical procedure. A catheter tipped with a balloon is threaded from a blood vessel in the thigh into the blocked artery. The balloon is inflated, compressing the plaque to enlarge the blood vessel and open the blocked artery. The balloon is deflated, and the catheter is removed. Coronary angioplasty is performed in a hospital and generally requires a stay of one or two days. Coronary angioplasty is successful about 90% of the time, but for one-third of patients, the artery narrows again within six months. The procedure can be repeated. It is less invasive and less expensive than coronary artery bypass surgery.

In coronary artery bypass surgery, a healthy artery or vein from an arm, leg, or chest wall is used to build a detour around the coronary artery blockage. The healthy vessel then supplies oxygen-rich blood to the heart. Bypass surgery is major surgery. It is appropriate for those patients with blockages in two or three major coronary arteries, those with severely narrowed left main coronary arteries, and those who have not responded to other treatments. It is performed in a hospital under general anesthesia. A heart-lung machine is used to support the patient while the healthy vein or artery is attached past the blockage to the coronary artery. About 70% of patients who have bypass surgery experience full relief from angina; about 20% experience partial relief. Only about 3–4% of patients per year experience a return of symptoms. Survival rates after bypass surgery decrease over time. At five years after surgery, survival expectancy is 90%; at 10 years about 80%, at 15 years about 55%, and at 20 years about 40%.

Various semi-experimental surgical procedures for unblocking coronary arteries are currently being studied. Atherectomy is a procedure in which the surgeon shaves off and removes strips of plaque from the blocked artery. In laser angioplasty, a catheter with a laser tip is inserted into the affected artery to burn or break down the plaque. A metal coil called a stent can be implanted permanently to keep a blocked artery open. Stenting is becoming more common.