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Heart rate, pulse pressure and mortality in patients with myocardial infarction complicated by heart failure Healed Culprit Plaques in Patients With Acute Coronary Syndromes Association of Plaque Location and Vessel Geometry Determined by Coronary Computed Tomographic Angiography With Future Acute Coronary Syndrome–Causing Culprit Lesions Effects of clopidogrel vs. prasugrel vs. ticagrelor on endothelial function, inflammatory parameters, and platelet function in patients with acute coronary syndrome undergoing coronary artery stenting: a randomized, blinded, parallel study Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction Imaging Coronary Anatomy and Reducing Myocardial Infarction Letter by Jiang et al Regarding Article, “Direct Comparison of Cardiac Myosin-Binding Protein C With Cardiac Troponins for the Early Diagnosis of Acute Myocardial Infarction” Improved outcomes in patients with ST-elevation myocardial infarction during the last 20 years are related to implementation of evidence-based treatments: experiences from the SWEDEHEART registry 1995-2014 High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial A Novel Circulating MicroRNA for the Detection of Acute Myocarditis
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Review ArticleVolume 13, Issue 1, January 2020

JOURNAL：JACC: Cardiovascular Interventions Article Link

Refractory Angina: From Pathophysiology to New Therapeutic Nonpharmacological Technologies

G Gallone, L Baldetti, G Tzanis et al. Keywords: cell therapy; coronary sinus reduce; renhanced external counterpulsation; extracorporeal shockwave myocardial revascularization; neuromodulation; refractory angina

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.

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