Refractory myocardial ischemic syndromes: patients’ characterization and treatment goals

Abstract

Experimental strategies such as gene transfer and/or cell transplantation have been explored to enrich collateral perfusion and improve contractility in severely ischemic cardiac patients. Nonetheless, the criteria used to define those patients are not uniform and need to be standardized. The authors propose herein standardized definitions in order to characterize the ‘no option’ ischemic cardiac patients as follows: lack of revascularization options; angina symptoms; limited exercise capacity; perfusion defects; an identifiable target myocardial region. In order to define a favorable clinical effect, the following end points should be the aim of treatment: improved exercise; reduced perfusion defects; improved angina or equivalent symptoms; augmented myocardial stress response; better quality of life parameters following treatment; improved collateral-dependent perfusion. The authors propose that such a systematic approach for patient evaluation should be considered to allow an accurate assessment of treatment efficacy and the comparison of results between alternative myocardial revascularization trials.