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The treatment of refractory chronic angina pectoris presents an increasing problem for all physicians caring for patients with coronary artery disease because of the large number of individuals who have either failed multiple revascularization procedures or are not appropriate candidates for such procedures.The aim of this study was to review the safety,efficacy,and clinical applicability of a noninvasive technique (external counterpulsation) for the treatment of angina pectoris.A MEDLINE search for all English language abstracts,meeting presentations,journal articles,and reviews from 1960 through December 2005 was conducted.