Coronary artery disease (CAD) is a manifestation of atherosclerosis that often leads to patients suffering from angina, myocardial infarction, congestive heart failure, and ultimately, death. Over 10 million Americans suffer from angina pectoris,49 a symptom resulting from the decreased flow of blood to the heart muscle from ischemic heart disease which is associated with CAD, and often described as chest pain. Angina can provide an early signal of ischemic heart disease . There are a number of treatments for angina. Angina pectoris is typically categorized according to the Canadian Cardiovascular Society’s functional classification system ( Table 1 ).
Currently available options for treating CAD include: lifestyle changes in conjunction with drug therapy, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery. Unfortunately, a growing number of patients who have medically refractory angina caused by diffuse CAD are not eligible for conventional revascularization7,50 or would be incompletely revascularized by CABG alone.38 The hallmark of this patient population is the presence of diffuse CAD. Medically refractory patients suffering from stable chronic angina with an area of their heart muscle not amenable to traditional revascularization may benefit from transmyocardial revascularization (TMR).