title: Noninvasive therapy for the management of patients with advanced coronary artery disease.
abstract: OBJECTIVE
  To determine the efficacy of cardiac shock wave therapy (CSWT) in the management of patients with end-stage coronary artery disease (CAD).
  
  
  BACKGROUND
  Patients with end-stage CAD have symptoms such as recurrent angina, breathlessness, and other debilitating conditions. End-stage CAD patients are usually those who have angina pectoris following a coronary artery bypass surgery or a percutaneous coronary intervention. These patients are refractory to optimal medical therapy and not fit for a redo procedure, and are often termed as 'no option' patients.
  
  
  METHODS
  We carried out a prospective cohort study to examine the effects of CSWT application in patients who had end-stage CAD and were no option patients. Characteristics such as angina class scores and functional status scores among cases (patients with end-stage CAD who received CSWT) and controls (patients with end-stage CAD who did not receive CSWT) were compared at baseline and at 6 months after CSWT therapy.
  
  
  RESULTS
  There were 43 patients in the case group and 43 patients in the control group. The mean age of the patients was 58.7 ± 9.5 years in the case group and 56.6 ± 11.6 years in the control group. Other characteristics such as the prevalence of diabetes, hypertension, coronary artery bypass graft and percutaneous coronary intervention were similar in both groups. Clinical results showed a significant improvement in exercise time between the cases and the controls 6 months after treatment with CSWT (20.1 ± 15.7 min in cases vs. 10.1 ± 4.2 min in controls; P<0.0001), and symptomatic improvement in the CCS class scores (1.95 ± 0.80 in cases and 2.63 ± 0.69 in controls; P<0.0001) and NYHA class scores (1.95 ± 0.80 in cases vs. 2.48 ± 0.59 in controls; P<0.001). In the control group, there was no improvement in angina class, functional class and exercise time.
  
  
  CONCLUSIONS
  The present study shows that CSWT application to the ischemic myocardium in patients with refractory angina pectoris improved symptoms and reduced the severity of ischemic areas at 6 months after CSWT treatment compared with the baseline. No side effects were observed with this therapy.
authors.affiliation: Karachi Medical and Dental College, Pakistan. wakaz@hotmail.com
authors.forename: Waqar H
authors.initials: WH
authors.lastname: Kazmi
authors.forename: Syed Z
authors.initials: SZ
authors.lastname: Rasheed
authors.forename: Saeed
authors.initials: S
authors.lastname: Ahmed
authors.forename: Mohammad
authors.initials: M
authors.lastname: Saadat
authors.forename: Saqib
authors.initials: S
authors.lastname: Altaf
authors.forename: Abdus
authors.initials: A
authors.lastname: Samad
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D012720:Severity of Illness Index; D012780:Short-Wave Therapy / Q000379:methods*; D016896:Treatment Outcome