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Long-Term, Time-Dependent Effects of Spinal Cord Stimulation for Refractory Angina Pectoris: A Prospective,
Szymon Hoppe1, Teresa Rusicka2, Jan Klimowicz3
1Medical Faculty of University of Science and Technology in Bydgoszcz, Bydgoszcz, Poland; Department of Neurosurgery, 10th Military Research Hospital in Bydgoszcz, Bydgoszcz, Poland.
Summary
Spinal cord stimulation (SCS) significantly improves clinical, cardiac, and psychosocial outcomes for refractory angina pectoris (RAP) patients long-term. These positive effects on quality of life and cardiac function demonstrate SCS efficacy in managing this condition.
Area of Science:
- Cardiology and Neuromodulation
- Investigates the long-term efficacy of spinal cord stimulation (SCS) in managing refractory angina pectoris (RAP).
Background:
- Refractory angina pectoris (RAP) poses a significant clinical challenge with ongoing debate regarding treatment efficacy.
- Limited long-term (>1 year) studies exist on the clinical, cardiac, and psychosocial impact of SCS for RAP.
Purpose of the Study:
- To conduct a comprehensive, long-term longitudinal analysis of SCS in patients diagnosed with refractory angina pectoris (RAP).
- To evaluate the clinical, cardiac, and psychosocial efficacy of SCS over a 36-month period.
Main Methods:
- Prospective, longitudinal cohort study involving patients with RAP undergoing SCS implantation.
- Assessment of clinical status (CCS, NYHA), cardiac function (echocardiography, exercise tolerance), pain (VAS, Laitinen), nitroglycerin use, and quality of life (SAQ, BDI, SWLS) at baseline, 6, and 36 months post-implantation.
- Statistical analysis using Friedman's rank or repeated-measures ANOVA with appropriate post hoc tests and multiple comparison correction.
Main Results:
- Significant improvements observed in Canadian Cardiovascular Society (CCS) grade and New York Heart Association (NYHA) class post-SCS (p < 0.0001).
- Ejection fraction increased significantly from 44.7% to 56.2% (p < 0.001) at 36 months.
- Substantial reductions in pain scores (p < 0.001) and nitroglycerin use, alongside significant positive impacts on Seattle Angina Questionnaire domains, depressive symptoms, and life satisfaction.
Conclusions:
- Spinal cord stimulation (SCS) demonstrates significant and sustained efficacy in improving clinical, cardiac, and psychosocial outcomes for patients with refractory angina pectoris (RAP).
- The observed time-dependent increases in treatment effects suggest cumulative physiological mechanisms, highlighting the need for extended follow-up in clinical trials to fully ascertain SCS benefits.
