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Comparison of patients undergoing enhanced external counterpulsation and percutaneous coronary intervention for
Richard Holubkov1, Elizabeth D Kennard, John M Foris
1Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Insights
Enhanced external counterpulsation (EECP) offers comparable survival to percutaneous coronary intervention (PCI) for high-risk angina patients. While PCI showed better symptom relief, EECP is a safe alternative for selected individuals with obstructive coronary disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Non-invasive Cardiology
Background:
- Enhanced external counterpulsation (EECP) is an emerging treatment for angina in patients unsuitable for revascularization.
- Percutaneous coronary intervention (PCI) is a standard revascularization therapy.
Purpose of the Study:
- To compare baseline characteristics and 1-year outcomes of patients receiving EECP versus elective PCI.
- To evaluate the safety and efficacy of EECP as an alternative to PCI in selected angina patients.
Main Methods:
- A comparative study of 323 patients treated with EECP (International EECP Patient Registry) and 448 patients treated with elective PCI (NHLBI Dynamic Registry).
- Analysis of baseline risk factors, comorbidities, left ventricular ejection fraction, and 1-year clinical outcomes including survival, major adverse cardiac events, and symptom status.
Main Results:
- EECP patients had a higher prevalence of risk factors (prior PCI, CABG, MI, CHF, diabetes) and lower ejection fraction compared to PCI patients.
- One-year survival (98.7% vs 96.8%) and repeat coronary artery bypass grafting rates (4.5% vs 5.7%) were comparable between EECP and PCI groups.
- Fewer EECP patients were symptom-free at 1 year (43.7% vs 73.4%), with higher rates of severe symptoms (15.5% vs 9.5%) compared to PCI.
Conclusions:
- For selected PCI candidates, EECP demonstrates comparable 1-year major event rates to elective PCI.
- While PCI offers superior symptom improvement, EECP represents a safe treatment option for specific obstructive coronary disease patients.
- Further research is needed to optimize patient selection for EECP therapy.
Abstract:
Enhanced external counterpulsation (EECP) has recently emerged as a treatment option for angina in selected patients suitable for revascularization with percutaneous coronary intervention (PCI). We compared baseline characteristics and 1-year outcome in 2 cohorts of PCI candidates presenting with stable symptoms: 323 patients treated with EECP in the International EECP Patient Registry (IEPR), and 448 NHLBI Dynamic Registry patients treated with elective PCI. Compared with patients receiving PCI, IEPR patients had a higher prevalence of many risk factors including prior PCI (53.0% vs 33.3%, p <0.001), prior coronary artery bypass grafting (42.1% vs 18.6%, p <0.001), prior myocardial infarction (56.4% vs 27.8%, p <0.001), history of congestive heart failure (16.8% vs 9.2%, p <0.01), and history of diabetes (37.9% vs 23.5%, p <0.001). Left ventricular ejection fraction was lower among IEPR patients (mean 50.3% vs 59.2%, p <0.001). At 1 year, survival was comparable in the 2 cohorts (98.7% IEPR vs 96.8% PCI, p = NS), as were rates of coronary artery bypass grafting during follow-up (4.5% IEPR vs 5.7% PCI, p = NS). At 1 year, 43.7% of IEPR patients reported no anginal symptoms compared with 73.4% of Dynamic Registry patients (p <0.001). Rates of severe symptoms (Canadian Cardiovascular Society class III, IV, or unstable) at 1 year were 15.5% among IEPR patients and 9.5% in the Dynamic Registry (p = 0.02). PCI candidates suitable for and treated with EECP had 1-year major event rates comparable to patients receiving elective PCI. Although PCI was associated with substantially lower rates of 1-year symptoms, EECP may be a safe treatment option for selected patients with obstructive coronary disease.