Florentina Dewi Pramesuari, Muhammad Reva Aditya, Mustika Mahbubi
Refractory Angina (RA) is a chronic condition unresponsive to standard treatments like Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Grafting (CABG), leaving limited options for many patients. Cardiac Shockwave Therapy (CSWT) is a novel, non-invasive modality that improves myocardial perfusion of stimulating microvascular regeneration. The present systematic review and meta-analysis were designed to assess the therapeutic efficacy of CSWT in patients with RA. Relevant studies were identified through a structured search of major electronic databases, including Cochrane, PubMed, and ScienceDirect, including comparative studies with controls that evaluated CSWT in RA patients between 2010 and 2024. Studies not in English, with irrelevant outcomes, or lacking full-text access, were excluded. Data were extracted and analyzed using a random-effects model to address heterogeneity. Seven studies with a total of 417 patients were analyzed. CSWT demonstrated significant improvements in multiple clinical outcomes. CSWT reduces angina severity in CSWT reduces angina severity in CCS grade (MD -0.76, 95% CI -0.97, -0.55, P < 0.00001) and in NYHA class (MD -0.62, 95% CI -0.95, -0.30, P = 0.0002), increased the 6-Minute Walk Test (6MWT) distance by 57.63 meters (MD 57.63, 95% CI 16.71, 98.54, P = 0.006), increased SAQ scores by 10.96 points (MD 10.96, 95% CI 1.66, 20.26, P = 0.02), improved Left Ventricular Ejection Fraction (LVEF) by 4.43% (MD 4.43, 95% CI: 2.66 to 6.21, P< 0.01), and decreased nitroglycerin usage by 1.62 intake per week (MD -1.62, 95% CI -2.61, -0.62, P = 0.001). However, there was no significant difference in LVEDD between the two groups. CSWT appears to be a promising therapeutic option for patients with RA, demonstrating improvement in Canadian Cardiovascular Society (CCS) angina class, New York Heart Association (NYHA) class, 6-minute walk test distances, SAQ score, LVEF, and reducing nitroglycerin usage. © 2025 Indonesian Heart Association. All rights reserved.
Faculty of Medicine, Universitas Katolik Soegijapranata, Semarang, Indonesia; Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia; Department of Cardiology, RAA Soewondo Hospital, Pati, Indonesia
