Might gene therapy offer symptomatic relief for patients with 'no option' angina?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of gene therapy could relieve angina symptoms in patients who are not amenable to conventional revascularisation strategies. Altogether 60 papers were identified using the search below. Seven papers presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of the papers are tabulated. We conclude that, gene therapy for ischaemic heart disease is in its infancy with evaluation trials of novel vectors, delivery methods and targeted patient population. The initial results from the randomised clinical trials using gene therapy for severe CHD are interesting but clear benefits are yet to be demonstrated. Longer term outcomes from the AGENT trial and VIVA trials are awaited.