Refractory Angina: From Pathophysiology to New Therapeutic Nonpharmacological Technologies

Guglielmo Gallone, Luca Baldetti, Georgios Tzanis, Mario Gramegna, Azeem Latib, Antonio Colombo, Timothy D. Henry, Francesco Giannini

Research output: Contribution to journalReview articlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)1-19
Number of pages19
JournalJACC: Cardiovascular Interventions
Volume13
Issue number1
DOIs
Publication statusPublished - Jan 13 2020

Keywords

  • cell therapy
  • coronary sinus reducer
  • enhanced external counterpulsation
  • extracorporeal shockwave myocardial revascularization
  • neuromodulation
  • refractory angina

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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