title: The beneficial effect of extracorporeal shockwave myocardial revascularization in patients with refractory angina.
abstract: OBJECTIVE
  The incidence of patients with refractory angina (RA) is increasing. Medical therapy for RA is limited and prognosis is poor. Experimental data suggest that the use of Extracorporeal shockwave myocardial revascularization (ESMR) may contribute to angiogenesis and improve symptoms of angina in patients with RA. Purpose of our study is to determine the efficacy of cardiac shock wave therapy (ESMR) in the management of patients with nonrevascolarized coronary artery disease (CAD).
  
  
  METHODS
  We performed a prospective cohort study to examine the efficacy of ESMR applcation in patients with RA despite optimal medical therapy, not suitable for further PCI or CABG. Characteristics such as angina class scores (CCS class score), nitroglycerin consumption and hospitalization rate among cases (patients with RA who received ESMR) and controls (patients with RA who did not receive ESMR) were compared at baseline and 6 months after ESMR therapy. In patients receiveing d ESMR the effect of on cardiac perfusion was assessed.
  
  
  RESULTS
  There were 43 patients in the case group and 29 patients in the control group. The mean age of the patients was 70 ± 9.5 years in the case group and 71 ± 5.3 years in the control group. Other characteristics (diabetes, coronary artery bypass graft, percutaneus coronary intervention, baseline CCS class score) were similar in both groups. There was a significant improvement in CCS class score (1.33 ± 0.57 in cases and 1.92 ± 0.69 in controls; p = 0.0002), nitroglycerin consumption (20% in case cases, and 44.8% in controls; P < 0.03) and hospitalization rate significantly reduced (13.9% in case cases, and 37.9% in controls; P < 0.03). The patients who received ESMR, there was a significantly improvement in myocardial perfusion after 6 months with a 33% relative reduction of summed stress score (SSS) (p = 0.002).
  
  
  CONCLUSIONS
  This case control study demonstrates the beneficial effect of ESMR therapy on cardiac symptoms, myocardial perfusion and reduced hospitalization in patients with refractory angina. Ther current study supports a role for ESMR as a non-invasive therapuetic option for patients with RA.
authors.affiliation: Department of Cardiology, University Hospital S. Giovanni Battista, Turin, Italy. Electronic address: a.gianluca1@virgilio.it.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Alunni
authors.affiliation: Department of Cardiology, University Hospital S. Giovanni Battista, Turin, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Marra
authors.affiliation: Department of Cardiology, University Hospital S. Giovanni Battista, Turin, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Meynet
authors.affiliation: Department of Cardiology, University Hospital S. Giovanni Battista, Turin, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: D'amico
authors.affiliation: Department of Cardiology, University Hospital S. Giovanni Battista, Turin, Italy.
authors.forename: Pelloni
authors.initials: P
authors.lastname: Elisa
authors.affiliation: Department of Cardiology, University Hospital S. Giovanni Battista, Turin, Italy.
authors.forename: Annalaura
authors.initials: A
authors.lastname: Fanelli
authors.affiliation: Department of Cardiology, University Hospital S. Giovanni Battista, Turin, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Molinaro
authors.affiliation: Department of Cardiology, University Hospital S. Giovanni Battista, Turin, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Garrone
authors.affiliation: Department of Nuclear Medicine, University Hospital S. Giovanni Battista, Turin, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: Deberardinis
authors.affiliation: Department of Nuclear Medicine, University Hospital S. Giovanni Battista, Turin, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Campana
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016022:Case-Control Studies; D005260:Female; D019220:High-Energy Shock Waves / Q000009:adverse effects / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods*; D005996:Nitroglycerin / Q000627:therapeutic use; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin
keywords: Echocardiography; Refractory angina; Shock wave therapy