Glenn N. Levine, MD, FAHA, FACC

Refractory angina is a loosely defined term generally referring to the persistence of life-impacting angina despite maximal antianginal medications and, when possible, coronary revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]). Numerous novel pharmacotherapies and mechanical interventions have been proposed, and studies conducted, to treat patients with refractory angina.

It is generally accepted that drug-eluting stents (DES) decrease the risk of restenosis in native coronary arteries compared with bare metal stents. However, the overall safety and benefit of DES implantation, including long-term benefits, in saphenous vein bypass grafts remains the subject, at least to some extent, of continued evaluation.

The presence of coronary collateral circulation should be cardioprotective and beneficial, but the demonstration of such benefit has been more challenging.