Efficacy of enhanced external counterpulsation (EECP) was evaluated in 50 optimally treated patients with angina for whom revascularization was found impossible. After optimization of antianginal therapy all patients were randomized into 2 groups: main (EECP group) and control (doses of antianginal drugs were titrated up to maximally tolerated). Frequency of angina attacks during the week, doses of short-acting nitroglycerin and quality of life were evaluated. All patients underwent cardiopulmonary exercise testing. It is shown that standard course of EECP even in case of optimal medicamentous therapy leads to decreased frequency of angina attacks and necessity for short-acting nitroglycerin, increases exercise time and physical tolerance. It is drawn a conclusion that EECP is an effective method of treatment in patients with refractory angina even if they are optimally treated. Efficacy and safety of EECP significantly excels further attempts to intensify antianginal therapy.