Enhanced external counter pulsation in treatment of refractory angina pectoris: two year outcome and baseline factors associated with treatment failure

<p>Abstract</p> <p>Background</p> <p>Enhanced external counter pulsation (EECP) is a non-invasive treatment option for patients with refractory angina pectoris ineligible to further traditional treatment. The aim of this study was to evaluate the effect of EECP on patients at a Scandinavian medical centre and to investigate if outcome can be predicted by analysing baseline factors.</p> <p>Methods</p> <p>86 consecutive patients (70 male, 16 female) were treated with EECP and followed for two years post treatment. Canadian cardiovascular society (CCS) class was analysed, and medication and adverse clinical events were researched prior to EECP, at the end of the treatment, and at six, 12 and 24 months thereafter. Patients responding to therapy by improving at least one CCS class were compared with those who failed to respond. Any differences in background factors were recorded and analysed.</p> <p>Results</p> <p>79% of the patients responded to therapy by improving at least one CCS class. In general, the CCS class improved by one class after EECP treatment (3.05 before versus 2.14 after treatment). A total of 61.5% of the initial responders showed sustained improvement at the 12 month follow-up while 29% presented sustained improvement after 24 months. Treatment was most effective among patients suffering from CCS class III-IV angina pectoris, while patients suffering from CCS class II angina pectoris improved transiently but failed to show sustained improvement after the 12 month follow-up. Diabetes mellitus and calcium channel antagonists were more common among the non-responders (<it>p </it>< 0.05).</p> <p>Conclusion</p> <p>This study confirms the safety and efficiency of EECP as a treatment option for patients suffering from refractory angina pectoris. The therapy is most beneficial in patients suffering from severe angina (CCS III-IV) while sustained response to therapy could not be verified among patients suffering from CCS class II angina pectoris.</p

TRANSCUTANEOUS ELECTRICAL NERVE-STIMULATION FOR THE CONTROL OF PAIN

In this review article the neurophysiological mechanisms through which the effect of TENS can be explained will be discussed. The clinical studies on the effectiveness of TENS for the control of pain, both in the acute and chronic state, are summarized, including contradictory findings, mainly due to methodological problems in pain evaluation and placebo control. Since the effect of TENS, with respect to the pain condition that is treated, seems to be intensity and frequency dependent, attention will be payed on the different TENS modes. Finally the complications and contraindications are discussed

Spinal cord stimulation in refractory angina pectoris - Clinical results and mechanisms

Patients with therapeutically refractory angina pectoris do not respond to adequate anti-anginal medication and are not suitable anymore for revascularisation procedures. This group of patients has a poor quality of Life, since their exercise capacity is severely afflicted. A new additional therapy for patients with refractory angina is neurostimulation. The concept of neurostimulation is based on the ''gate control theory'', a model in which nociceptive unmyelinated fiber afferents (C and A delta) are inhibited by non-nociceptive myelinated fiber afferents. Patients treated with spinal cord stimulation (SCS) show an increase in exercise capacity and a concomitant reduction in myocardial ischemia. A reduction in anginal attacks and nitroglycerin intake is also reported. The mechanisms of action of SCS are unclear, although there is evidence of an increase in myocardial oxygen supply, as is shown in peripheral vascular disease. Sympathetic nervous activity, prostaglandins, and endogenous opiates may also play a role in pain suppression by SCS. As soon as the safety and the complication rate are established, SCS may be commonly used as an additional therapy in patients with so-called ''intractable angina pectoris''

Spinal cord stimulation in refractory angina pectoris - Clinical results and mechanisms

Patients with therapeutically refractory angina pectoris do not respond to adequate anti-anginal medication and are not suitable anymore for revascularisation procedures. This group of patients has a poor quality of Life, since their exercise capacity is severely afflicted. A new additional therapy for patients with refractory angina is neurostimulation. The concept of neurostimulation is based on the ''gate control theory'', a model in which nociceptive unmyelinated fiber afferents (C and A delta) are inhibited by non-nociceptive myelinated fiber afferents. Patients treated with spinal cord stimulation (SCS) show an increase in exercise capacity and a concomitant reduction in myocardial ischemia. A reduction in anginal attacks and nitroglycerin intake is also reported. The mechanisms of action of SCS are unclear, although there is evidence of an increase in myocardial oxygen supply, as is shown in peripheral vascular disease. Sympathetic nervous activity, prostaglandins, and endogenous opiates may also play a role in pain suppression by SCS. As soon as the safety and the complication rate are established, SCS may be commonly used as an additional therapy in patients with so-called ''intractable angina pectoris''

Sequelae of spinal cord stimulation for refractory angina pectoris. Reliability and safety profile of long-term clinical application

Background Spinal cord stimulation (SCS) is effective in the treatment of severe coronary artery disease (CAD) unresponsive to anti-anginal medication or revascularization procedures. However, there is still concern about its safety, Objective To investigate the reliability, morbidity, and mortality aspects of SCS in patients with refractory angina pectoris by studying the predictors of outcome, defined by efficacy, adverse events and mortality, in patients with CAD and SCS. Methods Fifty-seven patients (18 women) treated with SCS, aged 59.8 +/- 7.6 years (mean +/- SD) were studied retrospectively. They had suffered from manifest CAD for 9.4 +/- 4.9 years; 46 of them had experienced a myocardial infarction prior to the implantation; 28 had had a previous percutaneous transluminal coronary angioplasty; and 52 had undergone coronary artery bypass surgery, The mean left ventricular ejection fraction was 51.8 +/- 13.8%, All of the patients were being treated with two or three anti-anginal drugs. Results During 2042 patient-months follow-up, nine of the 57 patients died (annual mortality rate 6.5%). The percentage of adverse events requiring reprogramming or surgical reintervention was reduced from 83% for 18 patients with the Medtronic ITREL(R) lead to 33% for 39 patients with the ITREL II system, The clinical outcome was correlated positively with a left ventricular ejection fraction > 40% (P=0.0005), and negatively with a high cholesterol level (P=0.0042), more prior revascularizations (P=0.028), and a higher New York Heart Association classification (P=0.04). Conclusions Improvement of the SCS system reduced the equipment-related complication rate. The predictors of outcome are related to the traditional risk factors for CAD, The mortality rate of patients with refractory angina treated with SCS is similar to that of patients with CAD and stable angina pectoris