Refractory angina pectoris in end-stage coronary artery disease: Evolving therapeutic concepts

摘要: Refractory angina pectoris in coronary artery disease is defined as the persistence of severe anginal symptoms despite maximal conventional antianginal combination therapy. Further, option to use an invasive revascularization procedure such percutaneous balloon angioplasty or aortocoronary bypass grafting must be excluded on basis a recent angiogram. This syndrome, which represents end-stage disease, characterized by insufficiency but only moderately impaired left ventricular function. Almost all patients demonstrated triple-vessel with diffuse atherosclerosis, had one more myocardial infarctions, and undergone (70% cases). We present three new approaches antiischemic properties: long-term intermittent urokinase therapy, transcutaneous spinal cord electrical nerve stimulation, transmyocardial laser revascularization.