Table 4 Non‐pharmacologic options for patients with chronic stable angina.
Mechanism(s) of benefit | Advantages | Disadvantages | |||
---|---|---|---|---|---|
External enhanced counterpulsation (EECP) | Reduced aortic impedanceIncreased mean coronary perfusion pressure | Non‐invasiveNo major adverse effectsRelatively inexpensive | Minor adverse effects: leg discomfort and oedemaContraindications: severe CHF, AR, severe PVD and severe ectopy | ||
Myocardial laser revascularisation (PTMR and TMR) | Direct delivery of nutrients to ischaemic myocardium via laser created channelsDenervation of the left ventriclePromotion of angiogenesis | TMR can be used at time of CABGPTMR has low procedural morbidity | Significant placebo effect with both TMR and PTMRTMR—requires surgical or thoracoscopic approachNot widely availableBenefits of PTMR not clear | ||
Percutaneous coronary intervention (PCI) | Revascularise ischaemic myocardium | Reduction in angina in symptomatic patientsDefine coronary anatomy | InvasiveCostly |
AR, aortic regurgitation; CABG, coronary artery bypass grafting; CHF, congestive heart failure; PTMR percutaneous transmyocardial laser revascularisation; PVD, peripheral vascular disease; TMR, transmyocardial laser revascularisation.