Abstract: <h3>Background</h3> Enhanced external counterpulsation has been demonstrated to improve angina in patients with epicardial coronary disease (CAD) and in patients with microvascular angina without CAD. However, epicardial CAD and microvascular disease may coexist in the same patient and cause refractory angina. Enhanced external counterpulsation (EECP) may be of general utility in treating angina from either cause. <h3>Methods</h3> Coronary artery disease patients with refractory angina and a positive imaging stress test for regional ischemia in an area with normal perfusion by angiography were considered for inclusion. CAD included prior angioplasty, bypass surgery or catheterization demonstrating ≥ 50% stenosis of a major epicardial artery. Canadian Cardiovascular Society (CCS) angina class was assessed at baseline and after completion of a course of EECP (1 hour/day for a total of 35 hours). A follow-up imaging stress test was performed within 6 months of completing EECP. Statistical testing pre and post was performed by paired Student9s t test with significance at p<0.05. <h3>Results</h3> There were 15 patients (8 male, average age 67.6 ± 11.5 years), all of whom completed a 35-hour course of EECP. The CCS angina class improved from an average of 3.7 ± 0.5 to 1.8 ± 0.8 post therapy (p<0.05) with 14/15 improving ≥ 1 angina class. Post EECP imaging stress tests obtained in 11 patients demonstrated improvement/ resolution in ischemia in all the clinically improved patients (p<0.05). At an average follow-up of 4.9 ± 2.9 months, angina relief was maintained in all initially responding patients with an average angina class of 1.7 ± 0.9 (p<0.05). In intermediate term follow-up one patient developed worsening angina at 6.5 months and a second worsening angina at 8 months. Long term follow-up of up to 27.5 months has demonstrated persistent improvement in angina class in 12/15 patients. <h3>Conclusions</h3> EECP is an effective treatment for CAD patients with microvascular angina. Given its effectiveness in improving angina in patients with microvascular and epicardial CAD, EECP may be considered appropriate for any patient with refractory angina and demonstrable ischemia.
Publication Year: 2005
Publication Date: 2005-03-01
Language: en
Type: article
Indexed In: ['crossref']
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Cited By Count: 2
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