Refractory chronic stable angina - Now what?

Abstract

Two of these therapies, EECP and TMR, are available on a clinical basis, whereas SCS is being investigated in the United States in a randomized trial called STARTSTIM (Stimulation Therapy for Angina Refractory to Standard Treatment Intervention or Medication). Multiple studies have been done in Europe showing the efficacy of SCS, and this forms the background information for the STARTSTIM investigation. The pFOX inhibitors have not yet been approved by the FDA, although there is a pFOX inhibitor that is being used in Europe, apparently successfully. If and when the pFOX inhibitors are approved by the FDA, perhaps they will provide us an altemative therapy for our patients with refractory chronic stable angina. Refractory chronic stable angina is not going to go away and will no doubt become an increasing problem, particularly in older patients. All four therapies warrant consideration in patients who are not happy with their lifestyles and who continue to have symptoms that limit activities of daily living. At the present time, the four therapies outlined above should not be considered a substitute for modern maximum aggressive medical therapy and revascularization therapy in patients with chronic stable angina. They should be used in addition to these therapies in the patient whose angina persists and interferes with activities of daily living, resulting in an unhappy lifestyle.