A modified regimen of extracorporeal cardiac shock wave therapy for treatment of coronary artery disease

The 55 patients with severe CAD were randomly divided into 3 treatment groups. The control group (n = 14) received only medical therapy. In group A ( n = 20), CSWT was performed 3 times within 3？months. In group B ( n = 21), patients underwent 3 CSWT sessions/week, and 9 treatment sessions were completed within 1？month. Primary outcome measurement was 6-minute walk test (6MWT). Other measurements were also evaluated.The 6MWT, CCS grading of angina, dosage of nitroglycerin, NYHA classification, and SAQ scores were improved in group A and B compared to control group.A CSWT protocol with 1？month treatment duration showed similar therapeutic efficacy compared to a protocol of 3？months duration.We have registered on ClinicalTrials.gov, the protocol ID is CSWT IN CHINA.The most common treatments for coronary artery disease (CAD) are medications combined with percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG). While PCI and CABG are not without risks, overall results are satisfactory in patients who are suitable candidates. However, the prognosis for patients with refractory angina who are not candidates for PCI or CABG is poor as maximal medical therapy is ineffective in a large portion of these patients [1,2].Shock wave (SW) therapy has been used successfully to treat renal calculi (lithotripsy) and for a number of orthopedic disorders [3,4]. Recently, experiments have shown that SWs with energy output at approximately 10？% of what is used for lithotripsy can promote neovascularization of cardiac tissue [5,6]. Subsequent clinical studies have shown that cardiac shock wave therapy (CSWT) can significantly improve cardiac function in patients with severe CAD and refractory angina who are not candidates for PCI or CABG [7-15]. One study that treated 24 patients with ischemic heart failure and a left ventricular ejection fraction (LVEF) < 40？% with CSWT demonstrated that the treatment significantly improved the cardiac functions assayed