Extract
Coronary artery disease and its consequences, such as acute coronary syndromes and heart failure, has been a primary target of attempts to regenerate this vital organ with different cell types and/or growth and angiogenetic factors. After a flurry of excitement early on,1–4 the scientific community fell into the trough of disappointment after a series of neutral studies5–9 (Figure 1). A scientific statement of the Transnational AllianCe for regenerative Therapies In Cardiovascular Syndromes (TACTICS) international group for the comprehensive cardiovascular application of regenerative medicinal products now tries—in line with previous documents on the issue10,11—to find the way back to productivity as outlined in their ‘Global position paper on cardiovascular regenerative medicine.12 Regenerative technologies have provided the promise to expand the therapeutic armamentarium to address major unmet needs in cardiovascular medicine. Although promising, regenerative therapies have yet to demonstrate clinical benefits over standard-of-care. While the feasibility and safety of regenerative products has been demonstrated, trials and their meta-analyses so far only documented at best a trend towards efficacy. The international TACTICS consortium was assembled to address the compelling need for a critical reflection on the future of cardiovascular regenerative medicine. The consortium covers discovery and translational validation as well as clinical applications and regulatory hurdles and funding strategies, and provide recommendations to guide the future application of regenerative products.A far less common presentation of coronary artery disease is coronary spasm which is much more challenging to diagnose than the common form due to atherosclerotic plaques. Thus, the attempt of Noel Bairey Merz and colleagues to standardize the diagnostic criteria in their Special Article ‘International standardization of diagnostic criteria for vasospastic angina’ is a timely contribution.13 The criteria for vasospastic angina include the following: nitrate-responsive angina, transient ischaemic ECG changes, and documented coronary artery spasm. Adoption of these diagnostic criteria should improve the clinical diagnosis of this condition and facilitate research in this field.
