An open label, single-centre, randomized trial of spinal cord stimulation vs. percutaneous myocardial laser...

Area of Science:

• Cardiology
• Interventional Cardiology
• Pain Management

Background:

• Refractory angina pectoris significantly impacts patient morbidity.
• Percutaneous myocardial laser revascularization (PMR) and spinal cord stimulation (SCS) are treatment options for refractory angina.

Purpose of the Study:

• To compare the effectiveness of SCS and PMR in patients with refractory angina.

Main Methods:

• Randomized trial comparing SCS and PMR in 68 patients with Canadian Cardiovascular Society (CCS) class 3/4 angina and reversible perfusion defects.
• Primary outcome: exercise treadmill time over 12 months.
• Secondary outcomes: angina-free exercise capacity, CCS class, quality of life, and adverse events.

Main Results:

• No significant difference in exercise treadmill time between SCS and PMR groups at 12 months (P = 0.466).
• Similar improvements in angina-free exercise capacity, CCS class, and quality of life.
• SCS group experienced more adverse events, primarily angina or SCS system-related (P = 0.001).

Conclusions:

• Limited evidence suggests comparable effectiveness between SCS and PMR for refractory angina.
• SCS is associated with a higher incidence of adverse events in the initial 12 months.