One year follow-up of patients with refractory angina pectoris treated with enhanced external counterpulsation

Thomas Pettersson,Ola Ohlsson,Lars Edvinsson,Diodor Cojocaru,Susanne Bondesson,Angelica Wackenfors

doi:10.1186/1471-2261-6-28

Abstract

BackgroundEnhanced external counterpulsation (EECP) is a non-invasive technique that has been shown to be effective in reducing both angina and myocardial ischemia in patients not responding to medical therapy and without revascularization alternatives. The aim of the present study was to assess the long-term outcome of EECP treatment at a Scandinavian centre, in relieving angina in patients with chronic refractory angina pectoris.Methods55 patients were treated with EECP. Canadian cardiovascular society (CCS) class, antianginal medication and adverse clinical events were collected prior to EECP, at the end of the treatment, and at six and 12 months after EECP treatment. Clinical signs and symptoms were recorded.ResultsEECP treatment significantly improved the CCS class in 79 ± 6% of the patients with chronic angina pectoris (p < 0.001). The reduction in CCS angina class was seen in patients with CCS class III and IV and persisted 12 months after EECP treatment. There was no significant relief in angina in patients with CCS class II prior to EECP treatment. 73 ± 7% of the patients with a reduction in CCS class after EECP treatment improved one CCS class, and 22 ± 7% of the patients improved two CCS classes. The improvement of two CCS classes could progress over a six months period and tended to be more prominent in patients with CCS class IV. In accordance with the reduction in CCS classes there was a significant decrease in the weekly nitroglycerin usage (p < 0.05).ConclusionThe results from the present study show that EECP is a safe treatment for highly symptomatic patients with refractory angina. The beneficial effects were sustained during a 12-months follow-up period.

Highlights

Enhanced external counterpulsation (EECP) is a non-invasive technique that has been shown to be effective in reducing both angina and myocardial ischemia in patients not responding to medical therapy and without revascularization alternatives
The angina functional class did not change in 21% of the patients and importantly no patient changed to a higher cardiovascular society (CCS) class directly after EECP treatment
The improvement in CCS class was significant in patients with CCS class III and IV and persisted six and 12 months after EECP treatment, while there was no such reduction in angina status in patients with CCS class II (Figure 2)

Summary

Introduction

Enhanced external counterpulsation (EECP) is a non-invasive technique that has been shown to be effective in reducing both angina and myocardial ischemia in patients not responding to medical therapy and without revascularization alternatives. Treatment of coronary artery disease consists of pharmacological interventions and invasive actions such as percutaneous coronary interventions (PCI) and coronary bypass grafting (CABG) In spite of these generally successful means of treatment the number of patients with severe symptomatic ischemic chest pain has increased [2]. It has been reported that up to 15% of patients with angina pectoris meet the criteria for refractory angina [3] This is a significant clinical problem and the search for alternative therapies have yielded some new treatments such as Spinal Cord Stimulation (SCS) [4,5], left stellate ganglion blockade [2,6], thoracic epidural anesthesia [2,7] and Enhanced External Counter Pulsation (EECP) [8]. EECP therapy is one of the most promising treatments for relieving angina and has been shown to improve exercise tolerance in patients with symptoms of stable angina pectoris [9]

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