The immediate and long-term outcome of enhanced external counterpulsation in treatment of chronic stable refractory angina


Dr Poay Huan Loh, Academic Cardiology Department, University of Hull, Hull Royal Infirmary, Hull HU3 2JZ, UK.
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Background.  Treatment of angina recalcitrant to conventional pharmacological therapy and revascularization remains problematic. Safe, effective and affordable treatments with high patient acceptability are desirable. Enhanced external counterpulsation (EECP) may fulfil these criteria better than many other proposed interventions.

Objective.  To examine the immediate and long-term effect of EECP in treatment of chronic stable refractory angina.

Design.  Prospective observational study of consecutive patients treated with EECP and follow-up for 1 year.

Setting.  Teaching hospital.

Main outcome measures.  Canadian Cardiovascular Society (CCS) angina grading, weekly angina frequency and glyceryl trinitrate (GTN) use.

Results.  Sixty-one patients were treated with EECP and 58 completed a course of treatment. Further analysis is confined to those who completed EECP. About 52% of patients suffered from CCS III and IV angina prior to EECP. Immediately post-EECP, angina improved by at least one CCS class in 86% and by two classes in 59%. At 1-year follow-up, sustained improvement in CCS was observed in 78% of the patients. The median weekly angina frequency and GTN use were significantly reduced immediately after EECP [7 (4–14) vs. 1 (0–4) episodes per week and 7 (2–16) vs. 0 (0–2) times per week respectively, P < 0.0001; data in median (interquartile range)]. The reduction was sustained at 1-year follow-up. In 48 patients, their mean exercise time improved significantly after EECP [301 ± 130 s vs. 379 ± 147 s, P < 0.0001]. Major adverse treatment-related events were rare.

Conclusion.  This study shows that for patients who fail to respond to conventional measures, a high proportion gain symptomatic benefit from EECP.