Abstract
BackgroundEnhanced external counterpulsation (EECP) is a noninvasive treatment that can decrease limiting symptoms in patients with refractory angina pectoris (RAP). Identifying responders to EECP is important as EECP is not widely available and relatively time intensive.HypothesisThe effect of EECP treatment on physical capacity in patients with RAP can be predicted from baseline patient characteristics and clinical factors.MethodsThis explorative study includes all patients from a cardiology clinic who had finished one EECP treatment and a 6 min walk test pre and post EECP. Clinical data, including Canadian Cardiovascular Society (CCS) classification and left ventricular ejection fraction (LVEF), were assessed before treatment. If patients increased their 6 min walking distance (6MWD) by 10% post EECP, they were considered responders.ResultsOf the 119 patients (men = 97, 40–91 years), 49 (41.2%) were responders. Multinomial regression analysis showed that functional status (i.e., CCS class ≥3) (OR 3.10, 95% CI 1.12–8.57), LVEF <50% (OR 2.82, 95% CI 1.02–7.80), and prior performed revascularization (i.e., ≤ 1 type of intervention) (OR 2.77, 95% CI 1.06–7.20) were predictors of response to EECP (p < .05, Accuracy 63.6%). Traditional risk factors (e.g., gender, smoking, and comorbidities) did not predict response.ConclusionsEECP treatment should be considered preferentially for patients that have a greater functional impairment, evidence of systolic left ventricular dysfunction, and exposure to fewer types of revascularization, either PCI or CABG. Improvement in 6MWD post EECP could imply improvement in physical capacity, which is a likely contributor to improved well‐being among patients with RAP.
Highlights
Patients with refractory angina pectoris (RAP) experience chronic symptoms, characterized by chest pain, in the setting of coronary artery disease (CAD), which is uncontrolled despite optimized therapy.[1,2]
In the final reduced model (Table 3) patients with a greater baseline functional impairment, an objective systolic LV dysfunction, and unsuitable for further revascularization had around three times higher odds to be a responder to external counterpulsation (EECP) (p < .05)
EECP treatment should be considered for patients with RAP who have a greater functional impairment, objective evidence of systolic LV dysfunction, and exposure to fewer types of revascularization, either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)
Summary
Patients with refractory angina pectoris (RAP) experience chronic symptoms, characterized by chest pain, in the setting of coronary artery disease (CAD), which is uncontrolled despite optimized therapy.[1,2] In the European guidelines CAD is categorized as either acute coronary syndrome or chronic coronary syndrome, with RAP in the latter category.[3]. Hypothesis: The effect of EECP treatment on physical capacity in patients with RAP can be predicted from baseline patient characteristics and clinical factors. Methods: This explorative study includes all patients from a cardiology clinic who had finished one EECP treatment and a 6 min walk test pre and post EECP. Clinical data, including Canadian Cardiovascular Society (CCS) classification and left ventricular ejection fraction (LVEF), were assessed before treatment. If patients increased their 6 min walking distance (6MWD) by 10% post EECP, they were considered responders. Conclusions: EECP treatment should be considered preferentially for patients that have a greater functional impairment, evidence of systolic left ventricular dysfunction, and exposure to fewer types of revascularization, either PCI or CABG. Improvement in 6MWD post EECP could imply improvement in physical capacity, which is a likely contributor to improved well-being among patients with RAP
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