Spinal Cord Stimulation for the Treatment of Refractory Angina Pectoris: A Two‐Year Follow‐Up

Abstract

Twenty-three patients affected by severe, refractory angina were submitted to permanent spinal cord stimulation (SCS) and then followed in our outpatient clinic for 24 months. During the follow-up period, the number of weekly angina episodes drastically dropped from 9.2 (preimplant) to 1.8 in the 3rd, 2.5 in the 6th, 4.5 in the 12th, and 4.2 in the 24th month, with a statistically significant difference (P < 0.01) between the first and last values. A significant increase in the average exercise time from 320 +/- 120 seconds (in baseline condition) to 410 +/- 115 seconds (during SCS) was observed at the treadmill stress test (P < 0.01). SCS was well tolerated by all the patients. However, 7 patients died during follow-up (3 myocardial infarctions, 2 noncardiac deaths, and 2 sudden deaths). Three generators were replaced because of battery depletion after 15, 17, and 21 months. No serious complication was observed. In conclusion, in patients with otherwise intractable angina or already submitted to myocardial revascularization, SCS is very effective in reducing the number of angina episodes. The time of the work during exercise stress test is also significantly prolonged.

Thoracic Spinal Cord Stimulation Reduces the Risk of Ischemic Ventricular Arrhythmias in a Postinfarction Heart Failure Canine Model

“…23 Several studies have demonstrated the efficacy of SCS in improving exercise tolerance, decreasing the frequency of anginal episodes, and prolonging time to ECG signs of ischemia. 24,25 It does not mask new anginal pain or signs of myocardial ischemia, and there is no increase in the incidence of ventricular arrhythmias. 26 -28 Although the exact mechanisms of these reported clinical effects have not been clearly elucidated as yet, they are likely related not only to inhibition of pain transmission but also to the antiischemic properties of this therapy.…”

Cost-Effectiveness of Spinal Cord Stimulation versus Coronary Artery Bypass Grafting in Patients with Severe Angina Pectoris – Long-Term Results from the ESBY Study

“…About 80% of the patients subjected to SCS treatment have experienced significant relief of angina, reduced frequency of anginal attacks, reduced need for short-acting nitrates and improved quality of life in several studies; experimental as well as clinical studies have shown the efficacy of SCS in angina treatment [3, 4, 5, 6, 7, 8, 9]. …”

Interventional treatment of pain in refractory angina. A review

“…Patients experienced in total 4.2 episodes weekly at 1 year after procedure whilst the pre-implant incidence was 9.2 episodes per week (P < 0.01) (ref. 47 ). De Jongste et al reported a significantly decreased incidence of angina attacks and reduction in total number of ischaemic episodes within 48 hours in patients treated with SCS (ref.…”