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Published on: June 26, 2018
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.
Objectives:
There is ongoing debate about the efficacy of spinal cord stimulation (SCS) for refractory angina pectoris (RAP), but there are few long-term (>one year) studies of clinical, cardiac, and psychosocial efficacy. The objective of this study was to provide a comprehensive long-term longitudinal clinical and psychosocial analysis of SCS in patients with RAP.
Materials And Methods:
This was a prospective, longitudinal cohort study in patients with RAP receiving SCS at a tertiary referral center in Poland. Patients were assessed for clinical (Canadian Cardiovascular Society [CCS], New York Heart Association [NYHA] status), heart function (two-dimensional echocardiography, exercise tolerance test), pain (visual analog and Laitinen scales), nitroglycerin (GTN) use, and quality of life (Seattle Angina Questionnaire [SAQ], Beck Depression Inventory, and Satisfaction With Life Scale) metrics six months before SCS implantation and six and 36 months after implantation. Differences in variables before and after surgery were assessed with Friedman's rank or repeated-measures analysis of variance with distribution-appropriate post hoc tests and multiple comparison correction.
Results:
Of 21 enrolled participants, 18 completed the study and remained using SCS and fully independent at 36 months. CCS grade and NYHA class significantly improved after the procedure (p < 0.0001), with all patients improving to CCS grade 2 (88.9%) or 1 (5.6%). Ejection fraction significantly increased from a mean (SD) of 44.7% (15.8%) six months before SCS implantation to 56.2% (12.2%) at 36 months (p < 0.001). Pain scores significantly decreased from baseline to 36 months (p < 0.001), with most of the effect observed within the first six months, with corresponding decreases in GTN use. SCS had a time-dependent and significant positive impact on all domains measured by the SAQ (p < 0.001 for all domains), depressive symptoms, and overall life satisfaction.
Conclusions:
This study helps to resolve the debate on SCS efficacy in patients with RAP. There were significant quantitative increases in all treatment effects over time, suggesting cumulative physiological mechanisms that mandate sufficient follow-up in clinical trials to fully assess outcomes.
