[Treatment of terminal phase of ischemic cardiopathy]

Area of Science:

• Cardiology
• Vascular Medicine

Context:

• Significant advancements in treating ischemic heart disease (IHD) have been achieved through coronary care units (CCU), antithrombotic therapy, coronary artery bypass grafting (CABG), and percutaneous transluminal angioplasty (PTCA).
• Intrahospital mortality for IHD has decreased from 35% to under 10% due to these interventions.
• Improved quality of life is observed in patients surviving acute ischemic events.

Purpose:

• To address the challenges posed by end-stage coronary artery disease (CAD) patients who are not candidates for conventional treatments.
• To explore alternative therapeutic options for patients with advanced coronary obstructions.
• To highlight the importance of patient lifestyle adaptation and optimized medical management in advanced CAD.

Summary:

• Modern cardiovascular interventions have led to a greater number of patients surviving to advanced stages of ischemic heart disease.
• These "end stage" patients often present with complex coronary obstructions, precluding standard surgical or interventional procedures.
• Management requires intensive patient cooperation, lifestyle modification, risk factor elimination, and maximally tolerated, angina-scheduled medical therapy.
• Laser transmyocardial revascularization (LTMR) is an emerging option, showing clinical improvement but lacking definitive evidence of reduced ischemic segments.

Impact:

• Reduced mortality rates and improved quality of life for a large cohort of ischemic heart disease patients.
• The emergence of
• end stage
• cardiac patients necessitates the development and evaluation of innovative treatment modalities.
• Emphasizes the critical role of patient adherence and comprehensive medical management in optimizing outcomes for advanced cardiovascular disease.