Chronic myocardial ischemia: contemporary management strategies

The presence of chronic myocardial ischemia signifies an imbalance between myocardial oxygen supply and demand that usually reflects the existence of advanced atherosclerotis coronary disease. Standard therapies for this condition that have evolved over the past 40 years include drugs primarily designed to reduce myocardial oxygen demand or improve flow through the existing vessels. In a select group of patients this approach is supplemented by coronary bypass grafting or coronary angioplasty. A new and currently evolving approach relies on stimulation of growth of new coronary vessels to improve myocardial perfusion that can be achieved either by the application of growth factors or mechanical means.