Objective: The aim of this study was to investigate the efficacy and safety of cardiac shock wave treatment (CSWT) in patients with non-revascularized coronary heart disease (nRCHD). Methods: A total of 87 nRCHD patients were randomly selected and divided into Group CSWT (62 cases, further subdivided into Group routine CSWT [A, 32 cases] and Group expanded CSWT [B, 30 cases]) and controls (Group CON [C, 25 cases]). Differences in clinical outcomes, cardiac perfusion, myocardial metabolism, and cardiac functional indexes were compared between these groups. Results: 1) No angina worsening, malignant arrhythmia, or other adverse reactions occurred during CSWT; 2) The secondary hospitalization rate in Group CSWT was less than that in Group CON; 3) Myocardial perfusion and metabolism, New York Heart Association functional class, Canadian Cardiovascular Society angina classification, Seattle Angina Questionnaire scores, 6-minute walkingtest results, and left ventricular ejection fraction (LVEF) were significantly improved with decreased nitroglycerin dosage in Group CSWT after treatment. Results were also better than those in Group CON during the same period (P < 0.05). Moreover, improvements in myocardial perfusion, myocardial metabolism, and LVEF in Group B were more significant than those in Group A (P < 0.05). Conclusion: 1) CSWT can be used in patients with complex coronary artery disease with/without prior revascularization; 2) Early CSWT can alleviate myocardial ischemic symptoms, improve myocardial perfusion and metabolism, improve coronary reserve, quality of life, and exercise tolerance, inhibit ventricular remodeling, and improve cardiac function. In addition, expanded CSWT is superior to routine CSWT.