Refractory angina pectoris in end-stage coronary artery disease: evolving therapeutic concepts

Am Heart J. 1997 Oct;134(4):587-602. doi: 10.1016/s0002-8703(97)70040-1.


Refractory angina pectoris in coronary artery disease is defined as the persistence of severe anginal symptoms despite maximal conventional antianginal combination therapy. Further, the option to use an invasive revascularization procedure such as percutaneous coronary balloon angioplasty or aortocoronary bypass grafting must be excluded on the basis of a recent coronary angiogram. This coronary syndrome, which represents end-stage coronary artery disease, is characterized by severe coronary insufficiency but only moderately impaired left ventricular function. Almost all patients demonstrated severe coronary triple-vessel disease with diffuse coronary atherosclerosis, had had one or more myocardial infarctions, and had undergone aortocoronary bypass grafting (70% of cases). We present three new approaches with antiischemic properties: long-term intermittent urokinase therapy, transcutaneous and spinal cord electrical nerve stimulation, and transmyocardial laser revascularization.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aged
  • Angina Pectoris / etiology
  • Angina Pectoris / therapy*
  • Coronary Disease / complications*
  • Coronary Disease / therapy
  • Electric Stimulation Therapy
  • Female
  • Humans
  • Laser Therapy
  • Male
  • Middle Aged
  • Multicenter Studies as Topic
  • Myocardial Revascularization / methods
  • Plasminogen Activators / therapeutic use
  • Severity of Illness Index
  • Spinal Cord
  • Transcutaneous Electric Nerve Stimulation
  • Urokinase-Type Plasminogen Activator / therapeutic use


  • Plasminogen Activators
  • Urokinase-Type Plasminogen Activator