Is hyperbaric oxygen therapy beneficial for coronary microvascular disease?

Hyperbaric Oxygen Therapy for Coronary Microvascular Disease

There is currently no evidence to support the use of hyperbaric oxygen therapy (HBOT) for coronary microvascular disease, and it should not be used for this indication.

Evidence Base and Rationale

Absence of Guideline Support

• No clinical guidelines recommend HBOT specifically for coronary microvascular disease 1
• Current HBOT recommendations are strictly limited to: neuro-ischemic diabetic foot ulcers where standard care has failed, necrotizing soft tissue infections, and carbon monoxide poisoning 1

Research Evidence on Acute Coronary Syndrome (Not Microvascular Disease)

While some older research examined HBOT in acute myocardial infarction, this is fundamentally different from coronary microvascular disease:

• A 2011 Cochrane review of 6 trials (665 patients) with acute coronary syndrome showed potential mortality reduction (RR 0.58,95% CI 0.36-0.92) and improved left ventricular ejection fraction 2
• However, the review concluded that routine application "cannot be justified" due to small sample sizes, methodological shortcomings, and poor reporting 2
• A 2021 pilot study (24 patients) with STEMI showed improved perfusion on SPECT imaging, but this was a small preliminary study requiring larger validation 3

Critical Distinction: ACS vs. Microvascular Disease

• The limited research available addresses acute coronary syndrome (epicardial vessel occlusion with myocardial infarction), not coronary microvascular disease (dysfunction of small coronary vessels without obstructive disease) 2, 4
• These are distinct pathophysiologic entities requiring different therapeutic approaches
• Extrapolating data from acute MI to chronic microvascular dysfunction is not scientifically valid

Significant Practical Barriers

Resource Limitations

• HBOT requires specialized facilities with limited availability 5, 1
• Treatment involves weeks of daily sessions, creating substantial time burden 1
• High costs without any established cost-effectiveness for cardiovascular indications 1

Potential Adverse Effects

• Claustrophobia occurs in approximately 15% of patients in single-occupancy chambers 2
• Other risks include barotrauma, oxygen toxicity, and complications from pressure changes 6

What Should Be Done Instead

For patients with suspected or confirmed coronary microvascular disease, focus on evidence-based interventions:

• Risk factor modification: Aggressive blood pressure control (target <120 mmHg systolic using standardized measurement), lipid management, diabetes control 1
• Pharmacologic therapy: ACE inhibitors or ARBs for patients with appropriate indications, antianginal medications (beta-blockers, calcium channel blockers, nitrates), and consideration of ranolazine for refractory angina
• Lifestyle interventions: Smoking cessation, exercise training, weight management

Common Pitfalls to Avoid

• Do not delay proven therapies while pursuing unproven interventions like HBOT 1
• Do not transfer patients to distant HBOT facilities for cardiovascular disease treatment, as this diverts resources from evidence-based care 1
• Do not confuse acute coronary syndrome research with applicability to chronic microvascular disease—these are different conditions requiring different approaches