Extracorporeal cardiac shock wave therapy ameliorates myocardial ischemia in patients with severe coronary artery disease

摘要

BACKGROUND: Prognosis of severe coronary artery disease with no indication of percutaneous coronary intervention or coronary artery bypass grafting still remains poor. We have recently demonstrated that extracorporeal cardiac shock wave therapy effectively induces neovascularization and improves myocardial ischemia in a porcine model in vivo. The aim of this study was to test the effects of shock wave therapy in patients with severe coronary artery disease. METHODS AND RESULTS: With permission of the ethical committee of our Institute, we treated 9 patients with severe coronary artery disease with no indication of percutaneous coronary intervention or coronary artery bypass grafting (5 males and 4 females, 55-82 years old)with our cardiac shock wave therapy (200 shots/spot at 0.09 mJ/mm2 for 20-40 spots, 3 times a week/series). We followed-up them at 1, 3, 6, and 12 months after the therapy to examine the time course of amelioration of myocardial ischemia. When needed, the shock wave therapy was performed up to 3 series at 0, and 1, 3 or 6 months. The cardiac shock wave therapy improved symptoms (CCS functional class score, from 2.7 +/- 0.2 to 1.8 +/- 0.2, p < 0.01) and reduced nitroglycerin use (from 5.4 +/- 2.5 to 0.3 +/- 0.3/week, p < 0.05). The treatment also improved myocardial perfusion as assessed by dipyridamole-stress thallium scintigraphy (severity score, 25.2 +/- 7.2% improvement, p < 0.05; extent score, 23.3 +/- 9.0% improvement, p = 0.07). The beneficial effects of the therapy persisted for 12 months. No procedural complications or adverse effects were noted. CONCLUSIONS: These results suggest that our extracorporeal cardiac shock wave therapy is an effective, non-invasive, and safe treatment for the treatment of severe coronary artery disease.