The beneficial effect of extracorporeal shockwave myocardial revascularization: Two years of follow-up

Cardiovasc Revasc Med. 2017 Dec;18(8):572-576. doi: 10.1016/j.carrev.2017.05.006. Epub 2017 May 10.


Objectives: Despite the advancements achieved by revascularization technique and pharmacological therapies, the number of patients with refractory angina (RA) is still high, carrying together a poor prognosis. Experimental data and small clinical studies suggest that the use of extracorporeal shockwave myocardial revascularization (ESMR) might improve symptoms of angina in patients with RA. The aim of our study is to evaluate the efficacy of cardiac shock wave therapy in a long term follow-up of patients with coronary artery disease (CAD) otherwise not suitable for revascularization.

Methods: We performed a prospective study enrolling patients with RA despite optimal medical therapy and without indication for further PCI or CABG. Characteristics such as angina class scores (CCS class score), nitroglycerin consumption and hospitalization were compared at baseline and 1, 6 and 12months after ESMR therapy.

Results: We enroll 72 patients with a mean age of 74.6±14.7years. We treated 440 echocardiographical segments of ischemical myocardium. During the longest published follow-up (2.88±1.65years, range 0.63-6.11) there was a significant reduction of medium CCS class score (from 2.78±0.67 to 1.44±0.6; p=0.0002), nitroglycerin consumption (67% vs 21%; p<0.001) and hospitalization rate (40% vs 18%; p<0.03).

Conclusion: Our study confirms the beneficial effect of ESMR therapy on cardiac symptoms and the possibility to reduce hospitalizations in patients with refractory angina also in a long term follow up. It supports a role for ESMR as a non-invasive therapeutic option for patients with RA.

Keywords: Echocardiography; Refractory angina; Shock wave therapy.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angina Pectoris / diagnostic imaging
  • Angina Pectoris / physiopathology
  • Angina Pectoris / therapy*
  • Echocardiography
  • Extracorporeal Shockwave Therapy* / adverse effects
  • Female
  • Follow-Up Studies
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Myocardial Ischemia / diagnostic imaging
  • Myocardial Ischemia / physiopathology
  • Myocardial Ischemia / therapy*
  • Myocardial Perfusion Imaging / methods
  • Myocardial Revascularization / adverse effects
  • Myocardial Revascularization / methods*
  • Prospective Studies
  • Time Factors
  • Tomography, Emission-Computed, Single-Photon
  • Treatment Outcome