Spinal cord stimulation versus other therapies in patients with Refractory Angina: A meta-analysis

An increasing number of patients with coronary disease suffer from angina that cannot be controlled by optimal medical management and revascularization. The purpose of this study was to evaluate the method of spinal cord stimulation (SCS) for the treatment of patients with refractory angina (RA).

We searched multiple databases, including PubMed, EMBASE, the Cochrane Library, and the Cochrane Central Register of Controlled Trials. The results of studies through March 2016 were included in our analyses. Systematic methodological appraisal and data extraction were conducted by two independent reviewers. All data analyses utilized the Review Manager 5.3, and the results were merged as weighted mean differences (WMD).

Nine randomized controlled trials (RCTs) with a total of 364 patients who were diagnosed with RA were included in the analysis. After being pooled, the outcomes of the SCS treatment group did not differ from coronary artery bypass grafting (CABG) or percutaneous myocardial laser revascularization (PMR) treatment groups. However, compared with 'no SCS stimulation' treatment groups, SCS significantly decreased nitrate drug usage (WMD: -2.03, 95% CI: [-3.12, -0.93], p=0. 0003) and increased several indicators of health-related quality of life (HRQOL).

SCS appears to be a safe and effective management for RA although it has similar efficacy when compared to PMR or CABG as a potential replacement therapy. However, before this method is used as a conventional treatment, more high-quality designed multicenter RCTs are needed.