Background: Patients who undergo coronary angioplasty have a shorter convalescence than those who undergo coronary bypass surgery. This may improve subsequent employment. Objective: To compare employment patterns after coronary angioplasty or surgery. Design: Multicenter, randomized clinical trial. Setting: Seven tertiary care hospitals. Patients: 409 employed patients with multivessel coronary artery disease. Intervention: Coronary bypass surgery or balloon angioplasty. Measurements: Time to return to work and time spent working during 4 years of follow-up. Results: Patients who underwent angioplasty returned to work 6 weeks sooner than patients who underwent coronary bypass surgery (P < 0.001), but long-term employment did not differ significantly (P > 0.2). Long-term employment was significantly lower among patients who were 60 to 64 years of age (P < 0.001), those who worked less than full-time at study entry (P < 0.001), and those who had less formal education (P = 0.005). Patients with only one source of health insurance were more likely to continue working (P = 0.005). Conclusions: Faster recovery after angioplasty speeds return to work but does not improve long-term employment, which is primarily associated with nonmedical factors.