Enhanced external counterpulsation as an adjunct to revascularization in unstable angina

Lawson, William; Cohn, Peter F.; Burger, R N Lynn; Katz, Jordan; Dervan, John P.; Zheng, Zhen Sheng; Oster, Zvi H.; Cabahug, Corazon; Hui, John C.K.; Jiang, Beibei; Soroff, Harry S.

doi:10.1002/clc.4960200217

Cited by 6 publications

(3 citation statements)

References 7 publications

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“…Pre-and posttreatment thallium scans and ETT provide objective evidence that EECP [14][15][16][17][18][19][20][21][22][23][24][25] is associated with resolution of reversible ischemia in many cases. Tissue pathology in animal studies [18][19][20][21] suggest collateral revascularization in the coronary arteries as one physiologic mechanism in which EECP leads to lasting subjective and objective improvement.…”

Section: Discussionmentioning

confidence: 99%

“…Tissue pathology in animal studies [18][19][20][21] suggest collateral revascularization in the coronary arteries as one physiologic mechanism in which EECP leads to lasting subjective and objective improvement. Patients who have had coronary artery bypass graft surgery before EECP are more likely to have improvement of ischemia; [14][15][16] researchers have suggested that the larger, patent grafts may increase diastolic aortic retrograde flow and enhance revascularization. Peripheral vascular effects may be another physiologic mechanism, as demonstrated by lower double product on ETT.…”

Section: Discussionmentioning

confidence: 99%

“…Potentially, these negative states, if allowed to persist, may adversely impact morbidity and mortality, and quality of life. Myocardial ischemia and cardiac mortality and morbidity can be lowered in patients with refractory angina by a noninvasive treatment called enhanced external counterpulsation (EECP), [14][15][16][17][18][19][20][21][22][23][24][25] which is described in more detail below. A previous study postulated that EECP may also have significant psychosocial effects.…”

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Psychosocial Effects of Enhanced External Counterpulsation in the Angina Patient: A Second Study

et al. 2001

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Psychosocial Effects of Enhanced External Counterpulsation in the Angina Patient: A Second Study

et al. 2001

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Prior revascularization increases the effectiveness of enhanced external counterpulsation

Lawson¹,

Hui

Guo

et al. 1998

Clinical Cardiology

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SummaryBtrckground and hypothesis: Enhanced external counterpulsation (EECP) is an effective noninvasive treatment for chronic angina. However, its usefulness has been felt to be limited in patients with angiographically demonstrated triplevessel coronary artery disease (CAD), in accord with the hypothesis that a patent vessel is necessary for transmission of the EECP-augmented coronary artery pressure and volume to the distal coronary vasculature.Md?ods: The effect of revascularization [coronary artery bypass grafting (CABG)] prior to EECP was examined in 60 patients with CAD and chronic angina (35 without and 25 with prior CABG). Patients were grouped by the extent of CAD (single-, double-, triple-vessel disease in the unrevascularized group) and by the extent ofresidual disease (number of stenotic native vessels unbypassed or supplied by a stenotic graft in the CABG group). Significant CAD or graft stenoses were defined as stenoses demonstrating 2 70% luminal diameter narrowing. Benefit was assessed by improvement in post-EECP treatment over pretreatment radionuclide stress testing.Krnrlrs: Radionuclide stress testing demonstrated a comparable favorable response (80 vs. 7 1 %: p = NS) in patients with prior CABG versus unrevascularized patients. Enhanced external counterpulsation was highly and comparably effective in patients with unrevascularized native single-and double-vessel CAD and in patients with CABG with residual sin- Conclusion:The results suggest a new role for EECP as an effective treatment for post CABG ischemia, despite extensive CAD and even in the presence of stenotic grafts.

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Long‐term prognosis of patients with angina treated with enhanced external counterpulsation: fiVe‐ year follow‐up study

Lawson

Hui

Cohn

2000

Clinical Cardiology

100

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Background: Enhanced external counterpulsation (EECP) is a noninvasive treatment for coronary artery disease (CAD) that has been used successfully in patients not responding to medical andor surgical therapy.Hypothesis: The study was undertaken to evaluate the effect of EECP on long-term prognosis in such patients.Methods: Major adverse cardiovascular events (MACE) were tracked in 33 patients with CAD treated with EECP. Patients were subgrouped based on whether or not they demonstrated an early improvement in radionuclide stress perfusion imaging (Responders vs. Nonresponders) and followed for MACE over a mean follow-up of 5 years. Patient population characteristics included 73% with multivessel disease; 45% with prior myocardial infarction(s); and 6 1 % who had undergone either coronary artery bypass grafling (CABG) or percutaneous transluminal coronary angioplasty (WCA), or both.Results: There were 26 of 33 (79%) Responders, and 7 of 33 (21%) Nonresponders. Subsequent MACE over the 5-year follow-up included four deaths and eight patients with cardiovascular events [acute myocardial infarct (4), new CABG or WCA (6), valve replacement (l), unstable angina (l)]. Nonresponders had signtficantly (p c 0.01) more MACE (6/7 or 86%) than Responders (6/26 or 23%). Overall, 21 of the 33 (64%) patients remained alive and without MACE and the need for revascularization 5 years post EECP treatment Conclusion: This study suggests that, particularly for the majority of patients demonstrating improvement in radionuclide stress perfusion post treatment, EECP may be an effective long-term therapy.

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Enhanced external counterpulsation as an adjunct to revascularization in unstable angina

Cited by 6 publications

References 7 publications

Psychosocial Effects of Enhanced External Counterpulsation in the Angina Patient: A Second Study

Psychosocial Effects of Enhanced External Counterpulsation in the Angina Patient: A Second Study

Prior revascularization increases the effectiveness of enhanced external counterpulsation

Long‐term prognosis of patients with angina treated with enhanced external counterpulsation: fiVe‐ year follow‐up study

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