Spinal Cord Stimulation for Medically Refractory Angina Pectoris: Can the Therapy Be Resuscitated?

Abstract

In this issue of Neuromodulation, DeJongste and coworkers present a careful study which once again demonstrates the significant utility and quality of life (QOL) outcomes to be expected from spinal cord stimulation (SCS) in patients suffering from medically intractable angina ( 1. Jitta DJ DeJongste MJ Kliphuis CM Staal MJ Multi-morbidity, the predominant predictor of quality-of-life, following successful spinal cord stimulation for angina pectoris. Neuromodulation. 2011; 14: 1 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar ). Despite several decades of experience with SCS for refractory angina and despite several high-quality studies demonstrating safety, efficacy, cost-effectiveness, and superiority to coronary artery bypass grafting (CABG), including randomized controlled trials ( 2. Ekre O Eliasson T Norrsell H Währborg P Mannheimer C Electrical stimulation versus coronary artery bypass surgery in severe angina pectoris. Long-term effects of spinal cord stimulation and coronary artery bypass grafting on quality of life and survival in the ESBY study. Eur Heart J. 2002; 23: 1938-1945 Crossref PubMed Scopus (119) Google Scholar , 3. Eddicks S Maier-Hauff K Schenk M Müller A Baumann G Theres H Thoracic spinal cord stimulation improves functional status and relieves symptoms in patients with refractory angina pectoris: the first placebo-controlled randomised study. Heart. 2007; 93: 585-590 Crossref PubMed Scopus (116) Google Scholar , 4. Hautvast RW DeJongste MJ Staal MJ van Gilst WH Lie KI Spinal cord stimulation in chronic intractable angina pectoris: a randomized, controlled efficacy study. Am Heart J. 1998; 136: 1114-1120 Crossref PubMed Scopus (195) Google Scholar , 5. Andréll P Ekre O Eliasson T et al. Cost-effectiveness of spinal cord stimulation versus coronary artery bypass grafting in patients with severe angina pectoris—long-term results from the ESBY study. Cardiology. 2003; 99: 20-24 Crossref PubMed Scopus (64) Google Scholar ), registry studies ( 6. Di Pede F Lanza GA Zuin G et al. Investigators of the prospective Italian registry of SCS for angina pectoris. Am J Cardiol. 2003; 91: 951-955 Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar , 7. Andréll P Yu W Gersbach P Gillberg L Pehrsson K Hardy I Long-term effects of spinal cord stimulation on angina symptoms and quality of life in patients with refractory angina pectoris—results from the European Angina Registry Link Study (EARL). Heart. 2010; 96: 1132-1136 Crossref PubMed Scopus (66) Google Scholar ), and systematic meta-analyses ( 8. TenVaarwerk IA Jessurun GA DeJongste MJ et al. Clinical outcome of patients treated with spinal cord stimulation for therapeutically refractory angina pectoris. The Working Group on Neurocardiology. Heart. 1999; 82: 82-88 Crossref PubMed Scopus (124) Google Scholar , 9. Börjesson M Andrell P Lundberg D Mannheimer C Spinal cord stimulation in severe angina pectoris—a systematic review based on the Swedish Council on Technology assessment in health care report on long-standing pain. Pain. 2008; 140: 501-508 Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar , 10. Taylor RS De Vries J Buchser E DeJongste MJ Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomised controlled trials. BMC Cardiovasc Disord. 2009; 9: 13 Crossref PubMed Scopus (107) Google Scholar ), SCS for refractory angina remains largely unknown to the general public and medical practitioners and is a relatively uncommonly performed procedure. Neuromodulation, as a field of medicine dedicated to decreasing the suffering of our patients, must ask why SCS for refractory angina is “flat-lining” and whether or not it can be resuscitated. Figure 2Artist rendering of spinal cord stimulation for refractory angina pectoris (Courtesy St. Jude Medical Neuromodulation). View Large Image Figure Viewer Download Hi-res image