6533b833fe1ef96bd129b727

RESEARCH PRODUCT

Management of refractory angina: an update.

Thomas F. LüscherThomas F. LüscherAlfredo R. GalassiShmuel BanaiSeppo Ylä-herttualaAllan DaviesKim Fox

subject

medicine.medical_specialtymedicine.medical_treatmentChronic coronary syndromeStemcell therapyCoronary Artery Disease030204 cardiovascular system & hematologyRevascularizationAngina PectorisAnginaCoronary artery disease03 medical and health sciencesCoronary artery bypass surgery0302 clinical medicinePercutaneous Coronary InterventionRestenosisInternal medicinemedicineMyocardial RevascularizationHumanscardiovascular diseases030212 general & internal medicineCoronary Artery BypassCoronary sinusbusiness.industryPercutaneous coronary interventionAnginamedicine.diseaseRadiation therapyChronic total occlusionSpinal cord stimulationConventional PCICardiologyQuality of LifeCardiology and Cardiovascular Medicinebusiness

description

Abstract Despite the use of anti-anginal drugs and/or percutaneous coronary interventions (PCI) or coronary artery bypass grafting, the proportion of patients with coronary artery disease who have daily or weekly angina ranges from 2% to 24%. Refractory angina refers to long-lasting symptoms (for >3 months) due to established reversible ischaemia, which cannot be controlled by escalating medical therapy with the use of 2nd- and 3rd-line pharmacological agents, bypass grafting, or stenting. While there is uncertain prognostic benefit, the treatment of refractory angina is important to improve the quality of life of the patients affected. This review focuses on conventional pharmacological approaches to treating refractory angina, including guideline directed drug combination and dosages. The symptomatic and prognostic impact of advanced and novel revascularization strategies such as chronic total occlusion PCI, transmyocardial laser revascularization, coronary sinus occlusion, radiation therapy for recurrent restenosis, and spinal cord stimulation are also covered and recommendations of the 2019 ESC Guidelines on the Diagnosis and Management of Chronic Coronary Syndromes discussed. Finally, the potential clinical use of current angiogenetic and stem cell therapies in reducing ischaemia and/or pain is evaluated.

10.1093/eurheartj/ehaa820https://pubmed.ncbi.nlm.nih.gov/33367764