Author + information
- Received March 25, 2019
- Revision received August 12, 2019
- Accepted August 20, 2019
- Published online January 6, 2020.
- Guglielmo Gallone, MDa,
- Luca Baldetti, MDb,
- Georgios Tzanis, MDb,
- Mario Gramegna, MDb,
- Azeem Latib, MDc@azeemlatib,
- Antonio Colombo, MDd,
- Timothy D. Henry, MDe,f and
- Francesco Giannini, MDd,∗ (, )@fra_giannini1@GVMCareResearch
- aDivision of Cardiology, Department of Medical Sciences, Città della Scienza e della Salute Hospital, University of Turin, Turin, Italy
- bUnit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
- cDepartment of Cardiology, Montefiore Medical Center, Bronx, New York
- dInterventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy
- eThe Christ Hospital Heart and Vascular Center / The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
- fUniversity of Florida, Gainesville, Florida
- ↵∗Address for correspondence:
Dr. Francesco Giannini, Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Via Madonna di Genova, 1, 48033 Cotignola RA, Italy.
• Refractory angina may be prevalent in 5% to 10% of stable coronary artery disease patients.
• Many emerging therapeutics may be suitable and efficacious to improve quality of life in refractory angina.
• Standardized sham-controlled trials’ design will be key to these treatments’ wide implementation.
Despite optimal combination of guideline-directed anti-ischemic therapies and myocardial revascularization, a substantial proportion of patients with stable coronary artery disease continues to experience disabling symptoms and is often referred as “no-option.” The appraisal of the pathways linking ischemia to symptom perception indicates a complex model of heart-brain interactions in the generation of the subjective anginal experience and inspired novel approaches that may be clinically effective in alleviating the angina burden of this population. Conversely, the prevailing ischemia-centered view of angina, with the focus on traditional myocardial revascularization as the sole option to address ischemia on top of medical therapy, hinders the experimental characterization and broad-scale clinical implementation of strongly needed therapeutic options. The interventionist, often the first physician to establish the diagnosis of refractory angina pectoris (RAP) following coronary angiography, should be aware of the numerous emerging technologies with the potential to improve quality of life in the growing population of RAP patients. This review describes the current landscape and the future perspectives on nonpharmacological treatment technologies for patients with RAP, with a view on the underlying physiopathological rationale and current clinical evidence.
- cell therapy
- coronary sinus reducer
- enhanced external counterpulsation
- extracorporeal shockwave myocardial revascularization
- refractory angina
Dr. Latib has served on the advisory board for Medtronic, Abbott, and CorFlow. Dr. Giannini has served as a consultant for Neovasc Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 25, 2019.
- Revision received August 12, 2019.
- Accepted August 20, 2019.
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