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

Abstract

Background: 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 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.

Methods: 55 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.

Results: EECP 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).

Conclusion: The 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.

Figure 1

Overall changes in CCS class before (pre-EECP, □) and after (post-EECP, ■) EECP treatment. The figure shows a shift towards improved CCS class after EECP treatment. Values are calculated as percentage of total number of patients and are presented as mean ± SEM.

Figure 2

Changes in angina status over a 12-months period in patients with CCS class IV (A), III (B), and II (C) prior to EECP treatments. The figure shows percentage of patients in each CCS class before EECP treatment (100%) and how many (%) of these patients that still are in the same CCS class immediately, six months and 12 months after the treatment. n = number of patients in the CCS class before EECP treatment. All values were compared to pre-EECP values in each CCS class and are presented as mean ± SEM.