Angina pectoris: current therapy and future treatment options

Abstract

Angina pectoris is the consequence of an inequality between the demand and supply of blood to the heart. Angina manifests itself as chest pain or discomfort and is a common complaint of patients in the hospital and in the clinic. There are, in fact, roughly half a million new cases of angina per year. Chest pain, while having many etiologies, is generally considered to be most lethal when related to a cardiac cause. In this review, the authors outline the current medical and surgical therapies that are used in the management of angina. Highlights of the various clinical trials that have assisted in the investigation of these therapies are summarized also. Then, the authors provide a focused review of the novel therapy options for angina that are currently being explored. From new medical treatments to revised surgical techniques to the discovery of stem cell therapy, many innovative options are being investigated for the treatment of angina.

Keywords::

• acute coronary syndrome
• angina pectoris
• balloon angioplasty
• β-blocker
• calcium channel blocker
• coronary artery bypass graft
• coronary artery disease
• nitrates
• percutaneous intervention
• ranolazine

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Current medical management of angina pectoris primarily centers around the use of β-blockers or nitrates to relieve symptoms.

• Several trials have shown varying data regarding the benefits of percutaneous coronary intervention and coronary artery bypass grafting and also comparing the two types of invasive treatments of angina has not been clear-cut.

• Ranolazine, despite its vast array of adverse effects, is currently being used as a new option for treatment of angina that is refractory to mainstream medications.

• New targets continue to develop that could potentially be successful in treating anginal symptoms.

• Invasive techniques, such as spinal cord stimulation and laser revascularization, may have added benefits as supplemental treatment options, being used in combination with nitrates or β-blockers.

• Future studies should begin to examine the effects of new options, both invasive and noninvasive treatments, in patients who have received previous percutaneous coronary intervention and coronary artery bypass grafting and see if this combination of treatments serves to improve morbidity and mortality.