Detection of antiischemic therapeutic effectiveness in patients with refractory angina pectoris and end-stage coronary artery disease – Long-term intermittent urokinase therapy

1998 ◽  
Vol 87 (14) ◽  
pp. s188 ◽  
Author(s):  
F.C. Schoebel ◽  
A.J. Peters ◽  
C.M. Schannwell ◽  
B. Holz ◽  
T.W. Jax ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Angina Pectoris ◽  
Therapeutic Effectiveness ◽  
Refractory Angina ◽  
Artery Disease ◽  
Refractory Angina Pectoris ◽  
End Stage

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

1997 ◽  
Vol 134 (4) ◽  
pp. 587-602 ◽  
Author(s):  
Frank C. Schoebel ◽  
O.Howard Frazier ◽  
Gilian A.J. Jessurun ◽  
Mike J.L. De Jongste ◽  
Kamuran A. Kadipasaoglu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Angina Pectoris ◽  
Refractory Angina ◽  
Therapeutic Concepts ◽  
Artery Disease ◽  
Refractory Angina Pectoris ◽  
End Stage

Intermediate-Term Clinical Outcome Following Transmyocardial Laser Revascularization in Patients With Refractory Angina Pectoris

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Carolyn K. Landolfo ◽  
Kevin P. Landolfo ◽  
G. Chad Hughes ◽  
Edward R. Coleman ◽  
Robin B. Coleman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Angina Pectoris ◽  
Perfusion Imaging ◽  
Functional Class ◽  
Refractory Angina ◽  
Transmyocardial Laser Revascularization ◽  
Artery Disease ◽  
Refractory Angina Pectoris

Background —This study was conducted to examine the intermediate-term clinical outcomes in patients with refractory angina pectoris treated with transmyocardial laser revascularization (TMR) at our institution. TMR is an alternative surgical technique for the treatment of myocardial ischemia and angina pectoris not amenable to conventional percutaneous or surgical revascularization. Limited data exist evaluating the natural history and duration of clinical improvement in angina pectoris following TMR. Methods and Results —Thirty-four patients with severe coronary artery disease unsuitable for treatment with standard revascularization techniques underwent TMR in myocardial regions determined to be ischemic by preoperative SPECT 201 Tl perfusion imaging following dipyridamole stress. Patients were assessed postoperatively at 3, 6, and 12 months for clinical outcomes including death, myocardial infarction, functional class of angina pectoris, and hospitalizations for unstable angina. Myocardial perfusion imaging by 201 Tl scintigraphy was also assessed at these temporal end points. Overall mortality at 1 year was 14.7% (n=5). Nonfatal myocardial infarction occurred in 3 patients (8.8%). Among the patients with complete 12-month follow-up (n =27), mean anginal class improved from 3.5±0.5 pre-TMR to 2.8±0.7 and 2.5±0.7 at 3 and 6 months, respectively, and 2.8±0.9 at 12 months. Overall improvement in angina pectoris was sustained at 1 year by at least one functional class in 50% of patients. Mean hospitalizations per year for unstable angina declined from 2.4±1.6 pre-TMR to 1.7±2.0 post-TMR ( P =0.01). There was no significant improvement in perfusion by SPECT 201 Tl imaging at any temporal end point post-TMR. Conclusions —Despite the lack of demonstrable improvement in perfusion by SPECT 201 Tl imaging, TMR improved the functional class of angina pectoris in patients with end stage coronary artery disease to a modest degree. Although the maximal benefit in symptoms occurred at 6 months post-TMR, mild sustained clinical improvement above baseline was evident in 50% of patients at 1 year.

scholarly journals Management of refractory angina pectoris

2004 ◽  
Vol 132 (11-12) ◽  
pp. 453-457
Author(s):  
Andjelka Ristic ◽  
Lazar Angelkov ◽  
Milorad Damnjanovic ◽  
Branislav Baskot
Keyword(s):  
Coronary Artery Disease ◽  
Angina Pectoris ◽  
Objective Measures ◽  
Refractory Angina ◽  
Transmyocardial Laser Revascularization ◽  
Number Of Patients ◽  
Conventional Medical Therapy ◽  
Artery Disease ◽  
Refractory Angina Pectoris ◽  
Enhanced External Counterpulsation

An increasing number of patients with coronary artery disease have ischemie symptoms that are unresponsive to both conventional medical therapy and revascularization techniques. The objective of this study was to define the population of patients with refractory angina pectoris and to present the therapeutic options currently available for this condition. Among many techniques, the enhanced external counterpulsation, transmyocardial laser revascularization and neurostimulation have been shown to reduce angina and to improve objective measures of myocardial ischemia in patients with refractory angina.

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