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

Abstract

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.

The Role of Enhanced External Counter Pulsation Therapy in Clinical Practice

“…12 The overall 5-year survival of EECP-treated patients was 88%, comparable to that seen with medical and revascularization therapies. At 5-years of followup, 64% of patients were alive without interim cardiovascular events or need for revascularization.…”

“…At 5-years of followup, 64% of patients were alive without interim cardiovascular events or need for revascularization. 12 The IEPR data also demonstrated an 83% reduction in hospitalization rates, compared to 6 months before EECP. About 86% of IEPR patients completed the 35-hour treatment.…”

Angiogenic effects of long-term enhanced external counterpulsation in a dog model of myocardial infarction

“…Several case study series and the International EECP Patient Registry, with more than 5,000 patients, have confirmed the benefits of EECP in providing symptomatic relief of angina (2, 7), improving blood flow to ischemic areas of myocardium [by radionuclide stress testing (6,12) and positron emission tomography (PET) scans (11)], eliminating or reducing nitrate use (10), as well as improving exercise tolerance (1,8). These effects have been reported to be sustained over several years (5,9). However, despite the observed acute hemodynamic effects (systolic unloading, diastolic augmentation, and increased coronary blood flow) during EECP treatment and the neurohormonal changes (increased nitric oxide and decreased endothelin) associated with treatment, the mechanisms of action that can induce long-term improvement in the angina status of CAD patients remain unclear (4).…”

A historical perspective towards a non-invasive treatment for patients with atherosclerosis

“…17 Benefits have been demonstrated to be durable in many patients for up to five years after treatment. 18 Extracorporeal shock wave therapy Another proposed treatment for patients with severe coronary artery disease with no options for PCI or surgery is extracorporeal cardiac shock wave therapy (ECST). Shock wave therapy has been widely used in lithotripsy or in the treatment of certain orthopaedic conditions.…”