Current and Future Treatment Strategies for Refractory Angina

Yang, Epic H.; Barsness, Gregory W.; Gersh, Bernard J.; Chandrasekaran, Krishnaswamy; Lerman, Amir
October 2004
Mayo Clinic Proceedings;Oct2004, Vol. 79 Issue 10, p1284
Academic Journal
Patients with refractory angina are not candidates for revascularization and have both class III or IV angina and objective evidence of ischemia despite optimal medical therapy. An estimated 300,000 to 900,000 patients in the United States have refractory angina, and 25,000 to 75,000 new cases are diagnosed each year. This review focuses on treatment strategies for refractory angina and includes the mechanism of action and clinical trial data for each strategy. The pharmacological agents that have been used are ranolazine, ivabradine, nicorandil, L-arginine, testosterone, and estrogen; currently, only L-arginine, testosterone, and estrogen are approved by the Food and Drug Administration. Results with the noninvasive treatments of enhanced external counterpulsation and transcutaneous electrical nerve stimulation are provided. Invasive treatment strategies including spinal cord stimulation, transmyocardial revascuiarization, percutaneous myocardial revascularization, and gene therapy are also reviewed.


Related Articles

  • Unstable Angina and Non --ST-Segment Elevation Myocardial Infarction: Part II.Coronary Revascularization,Hospital Discharge,and Post-Hospital Care. Wiviott, Stephen D.; Braunwald, Eugene // American Family Physician;8/1/2004, Vol. 70 Issue 3, p535 

    In the guideline developed by the American College of Cardiology and the American Heart Association, the management of suspected unstable angina and non--ST-segment elevation myocardial infarction (UA/NSTEMI) has four components: initial evaluation and management; hospital care; coronary...

  • C-Reactive Protein as a Pre-procedural Predictor of Early and Late Outcomes of Percutaneous Coronary Interventions. Aytekin, Saide; Çatako&gcaron;lu, Alp Bunk; Aytekin, Vedat; Kocazeybek, Bekir; Demiro&gcaron;lu, Cemşit; Demiro&gcaron;lu, Cem'i // International Journal of Angiology (Springer Science & Business ;Fall2003, Vol. 12 Issue 4, p229 

    To examine the predictive value of pre-procedural CRP level in patients undergoing percutaneous coronary intervention (PCI) regardless of having unstable or stable angina pectoris or myocardial infarction. Blood sampling for CRP measurement in patients undergoing PCI: 116 consecutive patients...

  • The sympathetic contributions to the cardiac plexus. Pather, N.; Partab, P.; Singh, B.; Satyapal, K. S. // Surgical & Radiologic Anatomy;Aug2003, Vol. 25 Issue 3/4, p210 

    Cardiac sympathetic denervation for intractable angina pectoris in patients unsuitable for conventional revascularization is currently gaining popularity since this procedure may be performed via minimally invasive surgery. A thorough understanding of cardiac innervation and its variations is...

  • BILATERAL CAROTID NERVE STIMULATION IN THE TREATMENT OF ANGINA PECTORIS. Geha, Alexander S.; Kleiger, Robert E.; Baue, Arthur E. // Angiology;Jan1974, Vol. 25 Issue 1, p16 

    Although the use of carotid sinus nerve stimulation has been quite limited, our experience and that of others with this mode of therapy and with direct coronary revascularization indicate that carotid sinus nerve stimulation may be preferable for the treatment of intractable angina pectoris in...

  • Drug Treatment of Stable Angina Pectoris in the Elderly. Kumar, Sanjay; Hall, Roger J. C. // Drugs & Aging;2003, Vol. 20 Issue 11, p805 

    Chronic stable angina pectoris (CSAP) resulting from coronary artery disease (CAD) is common in elderly patients, and significantly reduces their quality of life. Myocardial revascularisation procedures in this age group entail significant risks, largely related to comorbidities rather than...

  • CURRENT STATUS OF CORONARY SURGERY. May, Angelo // Angiology;Dec1977, Vol. 28 Issue 12, p879 

    At this time the treatment of angina pectoris, preinfarction angina, and myocardial infarction is still a primary responsibility of the internist or general practitioner and his consultants. Where medical measures are inadequate and where careful study including coronary angiography indicate to...

  • Gene Therapy for Relieving Angina. March, Keith L. // Medical Update;2004, Vol. 29 Issue 7, p6 

    Deals with gene therapy that help patients with angina disease. Information on the process of gene therapy.

  • Trials Available for Angina. March, Keith L. // Medical Update;2004, Vol. 29 Issue 7, p6 

    Looks at the angiogenic gene therapy in patients with stable angina trial in which genetic substance is infused into the arteries that supply the heart with oxygen. Statement from John Schleicker, participant in a gene trial for angina at Indiana Center for Vascular Biology and Medicine; Impact...

  • Prinzmetal's angina.  // Taber's Cyclopedic Medical Dictionary (2009);2009, Issue 21, p1893 

    A reference entry for the medical term "Prinzmetal's angina," another word for variant angina, is presented.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics