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Management of refractory angina: an update
Allan Davies1,2, Kim Fox1,2, Alfredo R Galassi3
1National Heart and Lung Institute, Imperial College, Guy Scadding Building, Dovehouse Street, London SW3 6LY, UK.
European Heart Journal
|December 28, 2020
Summary
Refractory angina affects 2-24% of coronary artery disease patients despite standard treatments. This review explores conventional and novel therapies to improve quality of life for these patients.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Refractory angina impacts 2-24% of coronary artery disease patients, persisting despite optimal medical therapy and revascularization.
- Symptoms are defined as long-lasting ( >3 months) chest pain due to reversible ischemia, significantly reducing patient quality of life.
- While prognostic benefits are uncertain, effective management of refractory angina is crucial for patient well-being.
Purpose of the Study:
- To review conventional pharmacological approaches for refractory angina, including guideline-directed drug combinations and dosages.
- To evaluate advanced and novel revascularization strategies for symptomatic and prognostic improvement.
- To discuss the potential of angiogenetic and stem cell therapies in managing refractory angina.
Main Methods:
- Literature review of conventional and novel treatments for refractory angina.
- Analysis of guideline-directed pharmacological therapies and dosages.
- Evaluation of advanced revascularization techniques and emerging therapies.
Main Results:
- Conventional treatments often fail to fully alleviate symptoms in refractory angina.
- Advanced strategies like chronic total occlusion PCI, spinal cord stimulation, and others show potential for symptom relief.
- Angiogenetic and stem cell therapies are under investigation for their role in reducing ischemia and pain.
Conclusions:
- Effective management of refractory angina requires a multimodal approach, combining optimized medical therapy with advanced interventions.
- Novel revascularization techniques and emerging regenerative therapies offer promising avenues for improving quality of life in refractory angina patients.
- Adherence to updated clinical guidelines, such as the 2019 ESC guidelines, is essential for managing chronic coronary syndromes.
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