title: Cardiac shock-wave therapy in the treatment of coronary artery disease: systematic review and meta-analysis.
abstract: OBJECTIVE
  To systematically review currently available cardiac shock-wave therapy (CSWT) studies in humans and perform meta-analysis regarding anti-anginal efficacy of CSWT.
  
  
  METHODS
  The Cochrane Controlled Trials Register, Medline, Medscape, Research Gate, Science Direct, and Web of Science databases were explored. In total 39 studies evaluating the efficacy of CSWT in patients with stable angina were identified including single arm, non- and randomized trials. Information on study design, subject's characteristics, clinical data and endpoints were obtained. Assessment of publication risk of bias was performed and heterogeneity across the studies was calculated by using random effects model.
  
  
  RESULTS
  Totally, 1189 patients were included in 39 reviewed studies, with 1006 patients treated with CSWT. The largest patient sample of single arm study consisted of 111 patients. All selected studies demonstrated significant improvement in subjective measures of angina symptoms and/or quality of life, in the majority of studies left ventricular function and myocardial perfusion improved. In 12 controlled studies with 483 patients included (183 controls) angina class, Seattle Angina Questionnaire (SAQ) score, nitrates consumption were significantly improved after the treatment. In 593 participants across 22 studies the exercise capacity was significantly improved after CSWT, as compared with the baseline values (in meta-analysis standardized mean difference SMD = -0.74; 95% CI, -0.97 to -0.5; p < 0.001).
  
  
  CONCLUSIONS
  Systematic review of CSWT studies in stable coronary artery disease (CAD) demonstrated consistent improvement of clinical variables. Meta-analysis showed a moderate improvement of exercise capacity. Overall, CSWT is a promising non-invasive option for patients with end-stage CAD, but evidence is limited to small sample single-center studies. Multi-center adequately powered randomised double blind studies are warranted.
authors.affiliation: Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. gburneikaite@gmail.com.|Centre of Cardiology and Angiology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania. gburneikaite@gmail.com.|, Room No A311, Santariskiu str. 2, 08661, Vilnius, Lithuania. gburneikaite@gmail.com.
authors.forename: Greta
authors.initials: G
authors.lastname: Burneikaitė
authors.affiliation: Moscow State University of Medicine and Dentistry, Moscow, Russia.|Yale- New Haven Health Bridgeport Hospital, Connecticut, United States of America.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Shkolnik
authors.affiliation: Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. jelena.celutkiene@santa.lt.|Centre of Cardiology and Angiology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania. jelena.celutkiene@santa.lt.
authors.forename: Jelena
authors.initials: J
authors.lastname: Čelutkienė
authors.affiliation: Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.|Centre of Cardiology and Angiology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
authors.forename: Gitana
authors.initials: G
authors.lastname: Zuozienė
authors.affiliation: Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.|Centre of Cardiology and Angiology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
authors.forename: Irena
authors.initials: I
authors.lastname: Butkuvienė
authors.affiliation: Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.|Centre of Cardiology and Angiology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
authors.forename: Birutė
authors.initials: B
authors.lastname: Petrauskienė
authors.affiliation: Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.|Centre of Cardiology and Angiology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
authors.forename: Pranas
authors.initials: P
authors.lastname: Šerpytis
authors.affiliation: Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.|Centre of Innovative Medicine, Vilnius, Lithuania.
authors.forename: Aleksandras
authors.initials: A
authors.lastname: Laucevičius
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
mesh_terms: D003324:Coronary Artery Disease / Q000503:physiopathology / Q000628:therapy*; D017079:Exercise Tolerance; D019220:High-Energy Shock Waves; D006801:Humans
keywords: Cardiac shock wave therapy; coronary artery disease; refractory angina; stable angina pectoris