Noninvasive therapy for the management of patients with advanced coronary artery disease

Coron Artery Dis. 2012 Dec;23(8):549-54. doi: 10.1097/MCA.0b013e328358a606.


Objectives: To determine the efficacy of cardiac shock wave therapy (CSWT) in the management of patients with end-stage coronary artery disease (CAD).

Introduction: 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.

Conclusion: 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.

Publication types

  • Comparative Study

MeSH terms

  • Coronary Angiography
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Positron-Emission Tomography
  • Prospective Studies
  • Severity of Illness Index
  • Short-Wave Therapy / methods*
  • Treatment Outcome