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Two-year outcomes in patients with mild refractory angina treated with enhanced external counterpulsation
William E Lawson1, John C K Hui, Elizabeth D Kennard
1Cardiovascular Division, SUNY Stony Brook, Stony Brook, New York 11794, USA. William.lawson@stonybrook.edu
Insights
Enhanced external counterpulsation (EECP) effectively reduces angina in patients with Canadian Cardiovascular Society (CCS) class II and III-IV, showing durable improvements and low major adverse cardiovascular events over two years.
Area of Science:
- Cardiology
- Noninvasive Cardiovascular Therapies
Background:
- International Enhanced External Counterpulsation Patient Registry (IEPR) data shows 85% of treated patients have Canadian Cardiovascular Society (CCS) class III-IV angina.
- These patients often have no further invasive revascularization options.
Purpose of the Study:
- To evaluate if enhanced external counterpulsation (EECP) benefits patients with less severe CCS class II angina.
- To assess if EECP's durable angina reduction extends to CCS class II patients without revascularization options.
Main Methods:
- A comparative analysis of 112 CCS class II patients versus 1346 CCS class III-IV patients from the IEPR.
- Evaluation of immediate response, 2-year durability, and clinical events following EECP treatment.
Main Results:
- EECP significantly reduced angina, nitroglycerin use, and improved quality of life in both CCS class II and III-IV groups.
- At 2-year follow-up, 74% of class II and 70% of class III-IV patients remained free of major adverse cardiovascular events (MACE).
- Both groups demonstrated durable improvement in CCS class over baseline.
Conclusions:
- Enhanced external counterpulsation (EECP) is effective for CCS class II refractory angina patients.
- EECP's noninvasive nature, effectiveness, and cost make it suitable for broader application in refractory angina treatment.
Background:
In the International Enhanced External Counterpulsation Patient Registry (IEPR), approximately 85% of the patients treated are in Canadian Cardiovascular Society (CCS) class III-IV with no option for further invasive coronary revascularization procedures.
Hypothesis:
This study sought to determine whether it is clinically important to establish whether the observed durable reduction in disabling severe angina with enhanced external counterpulsation (EECP) treatment can be extended to those with less severe CCS class II angina, who also have no option for further revascularization.
Methods:
This study evaluated the immediate response, durability and clinical events over a 2-year period after EECP treatment in 112 patients with Canadian Cardiovascular Society (CCS) class II angina versus 1346 patients with class III-IV angina using data from the International EECP Patient Registry (IEPR).
Results:
Treatment with EECP significantly (by at least one CCS class) reduced angina frequency, nitroglycerin use, and improved quality of life in both groups. At 2-year follow-up, 74% of class II and 70% of class III-IV patients remained free of major adverse cardiovascular events (MACE) and continued to demonstrate a durable CCS class improvement over baseline.
Conclusion:
The robust effectiveness of EECP as a noninvasive device, together with its relatively low start-up and recurrent costs, makes it an attractive consideration for treating patients with milder refractory angina in addition to the patient with severely disabling angina treated in current practice.
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