Enhanced External Counterpulsation in the Treatment of Chronic Refractory Angina: A Long‐term Follow‐up Outcome from the International Enhanced External Counterpulsation Patient Registry

Abstract

BackgroundThe management of patients who suffer from medically refractory angina and are unsuitable for conventional revascularization therapy is often unsatisfactory. Enhanced external counterpulsation (EECP) is a noninvasive treatment that is safe and effective immediately after a course of treatment. However, the duration of benefit is less certain.HypothesisTo evaluate the 3‐year outcome of EECP treatment.MethodsOne thousand four hundred and twenty seven patients from 36 centers registered in the International EECP Patient Registry (IEPR)—Phase 1 was prospectively followed for a median of 37 months. Two hundred and twenty patients (15.4%) died, while 1,061 patients (74.4%) completed their follow‐up.ResultsThe mean age was 66 ± 11 years and 72% were men. Seventy‐six percent had multivessel coronary disease for 11 ± 8 years. Eighty‐eight percent had a prior percutaneous or surgical revascularization and 82% were unsuitable for further coronary intervention.Immediately post‐EECP, the proportion of patients with severe angina (Canadian Cardiovascular Angina Classification [CCS] III/IV) were reduced from 89% to 25%, p<0.001. The CCS class was improved by at least 1 class in 78% of the patients and by at least 2 classes in 38%. This was sustained in 74% of the patients during follow‐up.Thirty‐six percent of the patients had CCS II or less angina, which was better than pre‐EECP state without a major adverse cardiovascular event during follow‐up. More severe baseline angina and a history of heart failure or diabetes were independent predictors of unfavorable outcome.ConclusionAn EECP improves angina and quality of life immediately after a course of treatment. For most of the patients, these beneficial effects are sustained for 3 years. Copyright © 2008 Wiley Periodicals, Inc.

Clinical effects of enhanced external counterpulsation treatment in patients with ischemic heart failure

“…Previous studies showed that improvement in NYHA class has been associated with a favorable prognosis (22,23). It has been shown that EECP treatment improved symptoms and functional capacity in patients with or without systolic HF (19)(20)(21) therapy (25). The results of our study supported previous studies findings because NYHA class was improved as above mentioned studies.…”

“…Sequential inflation of the cuffs, at the onset of diastole, produces aortic counterpulsation and an increase in diastolic pressure while rapid deflation of the cuffs, at the onset of systole, decreases systolic pressure in the vascular system (2). Unlike intraaortic balloon counterpulsation, EECP also increases venous return further, enhancing thus cardiac output (20,21). Furthermore, as diastolic inflation pressure is increased, the preload is increased, afterload is decreased, contractility is increased and mechanical efficiency is neutral (17).…”

Therapy for Angina Pectoris Secondary to Coronary Disease

“…Few studies have evaluated the long-term effects of EECP. Loh et al (Loh et al, 2008) used the International EECP Patient Registry (IEPR-1) that enrolled consecutive patients treated with EECP in more than 100 centers; follow-up duration was 3 years. These investigators found that immediately post-EECP, the proportion of patients with severe angina (CCS III/IV) was reduced from 89% to 25% (p<0.001).…”

The Role of Enhanced External Counterpulsation Therapy in the Management of Coronary Artery Disease

“…Results from the IEPR and the EECP Clinical Consortium have demonstrated that the symptomatic benefit observed in controlled studies translates to the heterogeneous patient population seen in clinical practice. Moreover, follow-up data indicate that the clinical benefit may be maintained for up to 5 years in patients with a favorable initial clinical response (Lawson et al 2000;Loh et al 2008) Soran et al, compared the efficacy, repeat EECP and 6-months major adverse cardiovascular events (MACE: Death/CABG/PCI/MI) free survival rates for patients treated with EECP for angina management in Europe (EU) with the United States (US); 4658 were treated and followed in the US and 262 in EU. EU were younger (p<0.001) with a higher proportion of men.…”