Background: Coronary artery disease is a frequently disease with high risk of complications and mortality. However, there are a large number of patients who are unsuitable for PO or CABG and patients have refractory angina after revascularization. Extracorporeal shock wave therapy (ESWT) can contribute to angiogenesis and improve symptoms of angina and enhance cardiac function and improve quality of life. Objective: To evaluate the effectiveness and safety of extra corporeal shock wave therapy in treatment of ischemic heart disease. Subject and method: 20 patients diagnosed multiple coronary disease with refractory angina and were treated at the 108 Military Central Hospital, underwent ESWT with the application of 100 shocks/spot at 0.09mJ/mm2 energy flux density for 3-6 spots each time and three times per week at each series for three series at 1,5,9 weeks. The following parameters will be evaluated including symptoms of angina, exercise tolerance, breathlessness, and echocardjographic and myocardial perfusion imaging characteristics after 3 months. Result: Rate of angina decreased statistically significant (number of chest pain per week from 14.5 +/- 3.7 to 3.2 +/- 1.3, time duration of chest pain per week from 178.5 +/- 22.4 second to 20.8 +/- 13.6 second, nitroglycerin used dose reduced from 8.7 +/- 2.4 pills to 1.0 +/- 0.5 pills, CCS angina class reduced from 2.63 +/- 0.9 to 1.95 +/- 0.8. six-minute walk test improved from 414 +/- 68.7 m to 526 +/- 89.5 m, breathlessness reduced from 85 percent to 50 percent and NYHA class scores (55 percent to 30 percent). Echocardiographic and myocardial perfusion imaging improved remarkably after ESWT. Conclusion: Extracorporeal shock wave therapy (ESWT) in ischemic heart disease is effective and safe.