Enhanced external counter pulsation (EECP) for refractory angina pectoris (RAP); results from a first case series

Enhanced External Counterpulsation (EECP) has emerged as a promising non-invasive modality not only for patients with refractory angina pectoris (RAP) but also for patients with heart failure. To our knowledge, no published data exists in Pakistan about the benefits of EECP. We report on a case series of 16 consecutive patients undergoing EECP. All patients were either deemed not to be candidates for revascularization or had failed revascularization with RAP on optimal medical therapy. Data was collected regarding the coronary anatomy, clinical presentation, Pre and Post EECP Canadian Cardiovascular Society (CCS) class, nitrate use and 6-min walk test. Patients with severe peripheral vascular disease and arrhythmias were excluded. The mean age was 56 +/- 11.1 years. Eight patients had 3-vessel disease. 4 post-CABG with occluded grafts and the rest with variable combination of coronary disease. Seven (44%) patients had Unstable Angina and 9 (56%) had Stable Angina. The mean 6 min walk distance before EECP was 295 +/- 148.60 meters and after EECP was 360 +/- 102.12 meters (p = 0.013). The CCS class before and after EECP also showed significant improvement (p = 0.017). Sublingual nitroglycerine use also showed a positive trend after EECP. EECP was noted to be a safe and effective modality for patients with RAP with statistically significant improvement in measures of quality of life.