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Nota: estas Diretrizes se prestam a informar e não a substituir o julgamento clínico do médico que, em última análise, deve determinar o tratamento apropriado para seus pacientes.

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Objective: To evaluate the safety, feasibility and initial and clinical effects on myocardial perfusion, intramyocardial, transthoracic administration of plasmid VEGF 165 in patients with advanced coronary artery disease and refractory angina, which are not qualified for percutaneous revascularization and surgery.Methods: A cohort study phase I. Thirteen patients with ischemic heart disease refractory angina despite maximum medical treatment for at least six months, not qualifying for surgical or catheter underwent intramyocardial injection of VEGF 165 plasmid 2000ìg. Patients were evaluated by myocardial scintigraphy, exercise testing, quality of life questionnaire (Minnesota) and determining the classes of heart failure (NYHA) and angina (CCS).Results: There were no deaths or recurrences. During the period of maximum medical treatment, there was no difference in myocardial scintigraphy, exercise stress tests and questionnaires on quality of life also found a trend towards worsening of NYHA class (P = 0.05) and CCS (P = 0.05) . Three months after intervention we observed improvements in scintigraphic SSS scores (18.38 ± 7.51 vs. 15.31 ± 7.29, P = 0.003) and SRS (11.92 ± 7.49 vs. 8.53 ± 6.68, P = 0.002) but not in proportion to the areal extent of ischemic Rev Bras Cir Cardiovasc 2010; 25(3): 311-321 of administration of VEGF. Clinical trials bring controversial results, many showing evidence of clinical improvement and angiogenesis [8][9][10][11][12][13][14][15][16][17][18][19] and others showing no differences in myocardial perfusion when compared to their controls [7,20]. Thus, although promising, remain still not completely clear the clinical effects on the myocardium vascularization of the therapy with VEGF in its various forms and ways of administration, justifying further studies. KALIL, RAK ET AL -VEGF gene therapy for angiogenesis in refractory angina: clinical trial phase I/IIThis clinical assay aims to evaluate the safety, feasibility and initial clinical effects (featuring a clinical assay phase I / II), under myocardial perfusion, intramyocardial, transthoracic administration of plasmid VEGF 165 in patients with advanced CAD and refractory angina, which are not qualified for surgery and percutaneous revascularization. We emphasize that we used for the first time, a plasmid entirely produced in Brazil.

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