[The problem of chronic refractory angina pectoris]

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Refractory angina pectoris (RAP) presents a poorer prognosis than stable angina.
• Patients with RAP often exhibit diffuse coronary artery disease and numerous cardiac risk factors, leading to a diminished quality of life.
• RAP patients are at higher risk for acute coronary events.

Purpose of the Study:

• To characterize patients with chronic stable angina, focusing on the prevalence and features of refractory angina pectoris.
• To identify patient subgroups within chronic stable angina, including those with severe coronary artery disease, those managed with conventional therapy, and those undergoing revascularization.

Main Methods:

• A cohort of 36 patients (35-70 years) with chronic stable angina underwent comprehensive evaluation, including coronary angiography, ECG, echocardiography, stress testing, and laboratory analyses.
• Patients were categorized based on coronary angiography findings, suitability for intervention, and response to therapy.
• Refractory angina pectoris was defined as persistent ischemic symptoms despite optimal medical therapy in patients deemed unsuitable for interventional procedures.

Main Results:

• Out of 36 patients, 15 (41.6%) were classified as having refractory angina pectoris.
• These refractory cases were characterized by ischemic heart disease symptoms persisting despite optimal medical management and unsuitability for interventional procedures due to factors like distal stenosis or diffuse arterial lesions.
• Severe stenosis (80-95%) or occlusion of the left main coronary artery was identified in 5 patients. 10 patients without significant main coronary artery stenosis received conventional anti-ischemic therapy. 11 patients underwent revascularization (4 CABG, 7 PCI).

Conclusions:

• A significant proportion of patients with chronic stable angina may develop refractory angina pectoris, characterized by persistent symptoms and unsuitability for revascularization.
• The findings highlight the challenges in managing refractory angina pectoris, emphasizing the need for further research into optimal therapeutic strategies for this patient group.