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Refractory angina pectoris in end-stage coronary artery disease: evolving therapeutic concepts
F C Schoebel1, O H Frazier, G A Jessurun
1Heinrich-Heine University Dusseldorf, Clinic for Cardiology, Pneumonology, and Angiology, Germany.
Insights
Refractory angina pectoris, severe chest pain despite treatment, may benefit from novel therapies. New approaches include urokinase therapy, electrical nerve stimulation, and transmyocardial laser revascularization for end-stage coronary artery disease.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Refractory angina pectoris is severe chest pain in coronary artery disease (CAD) unresponsive to maximal medical therapy.
- It signifies end-stage CAD with severe coronary insufficiency but moderate left ventricular dysfunction.
- Patients often have triple-vessel disease, prior myocardial infarctions, and previous bypass grafting.
Purpose of the Study:
- To introduce and discuss three novel anti-ischemic therapeutic approaches for refractory angina pectoris.
- To explore alternative treatment options beyond conventional therapies and invasive revascularization.
Main Methods:
- Presentation of three innovative treatment strategies: long-term intermittent urokinase therapy, transcutaneous and spinal cord electrical nerve stimulation, and transmyocardial laser revascularization.
- Focus on anti-ischemic properties of these novel interventions.
Main Results:
- The study presents three new therapeutic avenues with potential anti-ischemic effects.
- These methods offer alternatives for patients with end-stage coronary artery disease who are ineligible for or have failed conventional treatments.
Conclusions:
- Novel therapies like urokinase, electrical nerve stimulation, and laser revascularization show promise for managing refractory angina.
- These approaches may provide relief for patients with severe, end-stage coronary artery disease.
Abstract:
Refractory angina pectoris in coronary artery disease is defined as the persistence of severe anginal symptoms despite maximal conventional antianginal combination therapy. Further, the option to use an invasive revascularization procedure such as percutaneous coronary balloon angioplasty or aortocoronary bypass grafting must be excluded on the basis of a recent coronary angiogram. This coronary syndrome, which represents end-stage coronary artery disease, is characterized by severe coronary insufficiency but only moderately impaired left ventricular function. Almost all patients demonstrated severe coronary triple-vessel disease with diffuse coronary atherosclerosis, had had one or more myocardial infarctions, and had undergone aortocoronary bypass grafting (70% of cases). We present three new approaches with antiischemic properties: long-term intermittent urokinase therapy, transcutaneous and spinal cord electrical nerve stimulation, and transmyocardial laser revascularization.