Sixty-nine patients with severe angina pectoris were treated with acupuncture, Shiatsu and lifestyle adjustments, and were followed for 2 years. Forty-nine patients were candidates for coronary-artery bypass grafting (CABG), whereas bypass grafting was rejected in the remaining 20 patients. We compared our endpoint findings with those of a large prospective, randomized trial comparing CABG with percutaneous transluminal coronary angioplasty (PTCA). The incidence of death and myocardial infarction was 21% among the patients undergoing CABG, 15% among the patients undergoing PTCA and 7% among our patients. No significant difference was found concerning pain relief between the three groups. Invasive treatment was postponed in 61% of our patients due to clinical improvement, and the annual number of in-hospital days was reduced by 90%, bringing about an estimated economic saving of 12,000 US $ for each of our patients. Despite the fact that the men in the present study, had significantly less positive expectations towards the outcome of the treatment, when compared to the women, there was no significant difference concerning the effect. The study suggests that the combined treatment with acupuncture, Shiatsu and lifestyle adjustment may be highly cost effective for patients with advanced angina products.