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Alternative Therapies for Relief of Symptoms in Patients
with Refractory Angina
Î Enhanced external counterpulsation (EECP) may be considered for
relief of refractory angina in patients with SIHD. (IIb–B)
Î Spinal cord stimulation may be considered for relief of refractory
angina in patients with SIHD. (IIb-C: No Benefit)
Î Transmyocardial revascularization (TMR) may be considered for relief
of refractory angina in patients with SIHD. (IIb-B)
Î Acupuncture should not be used for the purpose of improving symptoms
or reducing cardiovascular risk in patients with SIHD. (III-C: No Benefit)
Additional Therapy to Reduce Risk of MI And Death
Î NOT recommended with the intent of reducing cardiovascular risk or
improving clinical outcomes:
No Benefit
• Estrogen therapy (III-A)
• Vitamin C, vitamin E, and beta-carotene supplementation. (III-A)
• Treatment of elevated homocysteine with folate or vitamins B6 and B12 (III-A)
• Chelation therapy (III-C)
• Garlic, coenzyme Q10, selenium, and chromium (III-C)
Revascularization
Î A Heart Team approach to revascularization is recommended in
patients with unprotected left main or complex CAD. (I-C)
Î Calculation of the STS (http://riskcalc.sts.org/STSWebRiskCalc273/
de.aspx) and SYNTAX (http://www.syntaxscore.com/calc/start.htm)
scores is reasonable in patients with unprotected left main and
complex CAD. (IIa-B)
