Prognostic implications of refractory angina

In the current era of widespread use of myocardial revascularization, angina has not disappeared. It is a common symptom among patients with stable coronary artery disease (affecting approximately 20% of patients) and has ominous prognostic implications in terms of subsequent risk of death and myocardial infarction. It is also associated with an increased risk of hospitalization for cardiovascular reasons and, as such, with increased costs. Refractory angina, (ie, chronic angina that cannot be controlled by a combination of medical therapy, angioplasty, and bypass surgery, where the presence of reversible myocardial ischemia has been clinically established to be the cause of the symptoms) is a more limited subgroup, given the spontaneous tendency for anginal symptoms to improve over time and the existing pharmacologic armamentarium to treat symptoms. However, refractory angina remains associated with a sizeable long-term mortality, estimated at 20% over 5 years, and has an important impact on patients’ quality of life. L Heart Metab. 2017;72:13-17