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急性冠脉综合征

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Phosphoproteomic Analysis of Neonatal Regenerative Myocardium Revealed Important Roles of CHK1 via Activating mTORC1/P70S6K Pathway Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With STEMI: The EXPLORE Trial Diagnosis and Prognosis of Coronary Artery Disease with SPECT and PET Use of Mechanical Circulatory Support Devices Among Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock 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 Association of the PHACTR1/EDN1 Genetic Locus With Spontaneous Coronary Artery Dissection Refractory Angina: From Pathophysiology to New Therapeutic Nonpharmacological Technologies Cardiovascular Mortality After Type 1 and Type 2 Myocardial Infarction in Young Adults Incidence and prognostic implication of unrecognized myocardial scar characterized by cardiac magnetic resonance in diabetic patients without clinical evidence of myocardial infarction Implications of Alternative Definitions of Peri-Procedural Myocardial Infarction After Coronary Revascularization

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.