Contrapulsación externa aumentada, un tratamiento no invasivo recomendado para la angina refractaria, valoración de la clase funcional y la calidad de vida

Abstract

IntroductionCoronary disease is an important cause for morbidity and mortality worldwide. Within this group there are patients with refractory angina. ObjectiveThe goal of this investigation was to assess efficiency and security of enhanced external counterpulsation (EECP) with 35 one-hour sessions, in a population assisted between December 2013 and November 2015. Material and methodsAnalytical observational recurrent cohort study. Patients who were referred for counterpulsation were selected. All of them were assessed in the beginning and after six months of the functional class of angina according to the Canadian Cardiovascular Society (CCS) and dyspnoea to the New York Heart Association (NYHA). Medication received and the procedures carried out were evaluated. The EQ-5D quality of life questionnaire was applied before and after six months. In order to establish the presence of differences in the follow-up of the functional class, the quality of life in the beginning and after six months, the Wilcoxon nonparametric test for paired data was used, with a significance level below 0.05. Data were analysed using SPSS version 20.0. ResultsInitial analysis of 74 patients, 50 men (67.6%), with an average age of 65.5 years. In the beginning of the therapy 74.4% of patients had class II - III dyspnoea (NYHA) and 77% class II - III angina (CCS). The median ejection fraction was 50.5% (35.0 - 60.0). The most important previous conditions were arterial hypertension 62 (83.8%) and diabetes mellitus 28 (37.8%). Medication received for angina and conducted procedures: betablockers 74 (100%), statins 71 (95.9%), aspirin 67 (90.5%), angiotensin-converting-enzyme inhibitors/angiotensin receptor antagonists 64 (86.5%), trimetazidine 56 (75.7%), nitrates 37 (50%), calcium antagonists 20 (27%), ivabradine 15 (20.3%), surgical revascularisation 41 (55.4%), percutaneous revascularisation 51 (68.9%), cardiovascular rehabilitation 45 (60.8%) and use of devices such as pacemakers, implantable cardioverter-defibrillators (CDI) or ICDs with synchronizers 19 (25.6%). After six months 45 patients who had finished the treatment were analysed, revealing that 91.1% was in class I - II dyspnoea (NYHA) and 93.2% were class I - II angina (CCS) (p<0.01 for both).For the quality of life assessment 36 patients who has filled out the EQ-5D were reviewed, thus finding a significant improvement in the mobility variable (p=0.021) and the visual analogue scale, with an initial median of 70.0 (RIQ: 50.0 – 80.0), that improved after six months to 80 (RIQ: 70.0 – 90.0), p=0.003. No complications for counterpulsation were found. ConclusionsEnhanced external counterpulsation therapy improves quality of life and functional class of angina and dyspnoea in patients with refractory angina and becomes a non-invasive, safe and efficient procedure.