Prognosis of severe coronary artery disease with no indication of percutaneous coronary intervention or coronary artery bypass grafting remains poor. We have recently demonstrated that shock wave therapy effectively induces neovascularization and improvesmyocardial ischemia in a porcinemodel in vivo. The aimof this study was to test this notion in patients with severe coronary artery disease. We treated nine patients with severe coronary artery disease with our cardiac shock wave therapy. We followed-up the patients at 1, 3, 6, and 12 months after the therapy to examine the amelioration ofmyocardial ischemia. When needed, shock wave therapy was performed up to three series at 0, and 1, 3 or 6 months. The cardiac shock wave therapy improved symptoms, nitroglycerin use, andmyocardial perfusion as assessed by dipyridamole stress thallium scintigraphy. These beneficial effects persisted for 12 months. No procedural complications or adverse effects were noted. These results suggest that our extracorporeal cardiac shock wave therapy is an effective and non-invasive treatment for severe coronary artery disease.