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Therapeutic options in chronic refractory angina

ESC Congress 2010

Coronary Artery Disease (Chronic)

With the elderly population increasing dramatically in the years to come, we will face large numbers of patients who still have symptoms despite revascularization and optimal pharmacotherapy.

Dr. Gitt from Ludwigshafen, Germany showed data from the recent Euro Hart Survey indicating that only 50% of patients with chronic angina had samples drawn for lipids and glucose. A German chronic angina registry revealed that despite adequate medical treatment, the 5 year mortality rate was >18%, with diabetes, reduced LVEF and PAD as negative prognostic factors.

20 years experience with Spinal Cord Stimulation (SCS) was elaborated by Dr Borjesson from Gothenburg, Sweden. More than 3000 patients worldwide have been treated with this modality which has an 80% success rate. It is not merely an analgesic treatment - a reduction in myocardial oxygen consumption possibly through reduced sympathetic output has been demonstrated in some studies.

Dr. Soran from Pittsburgh, US, gave an overview of her large experience in Enhanced External Counterpulsation – EECP, which has emerged as an important treatment option for this patient group during the last 15 years. This is an established treatment in many countries, with more than 200,000 patients treated worldwide and 15,000 in research programs. Randomized studies have shown effects on angina symptoms, exercise performance and LV function with clinical improvement in about 80%. The enhanced diastolic coronary perfusion and reduction of LV afterload improves LV function and stimulates angiogenesis through release of growth factors and NO.

Finally, Dr. Kastrup from Copenhagen, Denmark, discussed the possibilities of angiogenic therapy. After many negative studies with genes and vascular growth factors, subendocardial injections of Mesenchymal Stromal Cells (MSC) was very promising in a pilot study with respect to angina symptoms, nitroglycerine use and LV function, without any obvious adverse effects and several randomized studies are now under way.




Therapeutic options in chronic refractory angina
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.