Efficacy of Enhanced External Counterpulsation in Patients With Chronic Refractory Angina on Canadian Cardiovascular Society (CCS) Angina Class

Abstract

A growing number of patients with chronic artery disease suffer from angina, despite the optimal medical management (ie, β-blockers, calcium channel blockers, and long-acting nitrates) and revascularization. Currently, enhanced external counterpulsation (EECP) therapy has been verified as a noninvasive, safe therapy for refractory angina. The study was designed to evaluate the efficacy of EECP in patients with chronic refractory angina according to Canadian Cardiovascular Society (CCS) angina class.We identified systematic literature through MEDLINE, EMBASE, the Cochrane Clinical Trials Register Database, and the ClinicalTrials. gov Website from 1990 to 2015. Studies were considered eligible if they were prospective and reported data on CCS class before and after EECP treatment. Meta-analysis was performed to assess the efficacy of EECP therapy by at least 1 CCS angina class improvement, and proportion along with the 95% confidence interval (CI) was calculated. Statistical heterogeneity was calculated by I2 statistic and the Q statistic. Sensitivity analysis was addressed to test the influence of trials on the overall pooled results. Subgroup analysis was applied to explore potential reasons for heterogeneity.Eighteen studies were enrolled in our meta-analysis. Pooled analysis showed 85% of patients underwent EECP had a reduction by at least one CCS class (95%CI 0.81–0.88, I2 = 58.5%, P < 0.001). The proportion of patients enrolled at primarily different studies with chronic heart failure (CHF) improved by at least 1 CCS class was about 84% after EECP (95%CI 0.81–0.88, I2 = 32.7%, P = 0.1668). After 3 large studies were excluded, the pooled proportion was 82% (95%CI 0.79–0.86, I2 = 18%, P = 0.2528). Funnel plot indicated that some asymmetry while the Begg and Egger bias statistic showed no publication bias (P = 0.1495 and 0.2859, respectively).Our study confirmed that EECP provided an effective treatment for patients who were unresponsive to medical management and/or invasive therapy. However, the long-term benefits of EECP therapy needed further studies to evaluate in the management of chronic refractory angina.

Predictors of treatment benefits after enhanced external counterpulsation in patients with refractory angina pectoris

“…EECP has beneficial effects and has been used as an additional alternative when conventional therapy has not been successful to adequate symptom control, but 15–30% of treated patients do not experience neither subjective nor objective clinical improvement 12,16,24 . Identification of potential responders to EECP before treatment initiation could be reasonable as the treatment is not widely available, it is relatively time and resource intensive and a significant proportion of patients do not experience benefit.…”

Non-Pharmacological Interventions in Refractory Angina

“…The MUST-EECP study was an RCT that showed EECP to be associated with a significant decrease in angina frequency amongst patients with RA, as well as an improvement in time to ST-segment depression on stress testing. 23 Subsequently, a number of studies have corroborated these findings, with meta-analyses demonstrating that use of EECP is associated with improvements in anginal symptom burden 24,25 and myocardial perfusion. 26 In addition to the multitude of studies demonstrating the symptomatic benefit of EECP, the technique is also of proven effectiveness in reducing hospital expenditure.…”

Medium-term Effects of Enhanced External Counterpulsation in the Structural and Functional Parameters of Blood Vessels in Patients with Coronary Artery Disease

“…По данным мета-анализов работ с оценкой среднесрочных эффектов УНКП у пациентов со стабильной ИБС, в т.ч. осложненной ХСН, положительный эффект (снижение функционального класса стенокардии минимум на 1 единицу) отмечен у 84-86% пациентов [15,16].…”