Study	Type	Size	Endpoints	Results
MUST-EECP Arora et al., (33) 1999	Randomized Prospective placebo controlled multicentre	139 patients randomized CCS class I, II, or III	Exercise duration Daily average anginal attacks Nitroglycerin usage Time to 1 mm ST segment depression	Increase in time to 1 mm ST segment depression for active CP group, p=0.01 (adjusted mean: active CP 37±11 s vs. inactive CP –4+12s) Decrease in anginal episodes, p=NS (intent to treat) Decrease nitroglycerin use, p=NS (intent to treat) Increase in exercise duration, p=NS Active CP group reported more adverse events, p<0.001.
MUST-EECP (34) Arora et al., 2002	Randomized Prospective placebo controlled multicentre	71/139 randomized patients completed questionaires at baseline, end of therapy, and 12 months. Same study patients as Arora et al., (1999).	Health Related Quality of Life (HQOL) at end of treatment and 12 months	At end of treatment and 12-month follow-up, patients who had active EECP reported greater improvement than those having inactive EECP in all 4 primary HQOL quality of life parameters (p<0.05).
Schecter et al., (38) 2003	Comparative	40 patients (20 ECP and 20 age/gender matched controls who refused EECP)	Nitroglycerin tablets in the previous 24 hours. Change in CCS angina class.	EECP patients and nitroglycerine tablet usage: Pre EECP 4.2 (2.7); Post EECP 0.4 (0.5); p<0.001. Control patients and nitroglycerine usage: Pre EECP 4.5 (2.3); Post EECP 4.4 (2.6); p=0.87. EECP patients and change in CCS angina class: Pre EECP 3.5 (0.5); Post EECP 1.9 (0.3); p<0.0001. Control patients and change in CCS angina class: Pre EECP 3.3 (0.6); Post EECP 3.5 (0.5); p=0.89.
Barsness et al., (48) 2001	IEPR Registry	978 patients 69% of patients had CCS class III/IV [Candidates = patients suitable for revascularization. Noncandidates = patients not suitable for revascularization]	Anginal class Quality of life Adverse effects	Angina class improved post EECP Pre EECP: CCS I 5.5%; II 24.8%; III 48.1%; IV 21.6%. Post EECP: 36.0%; 32.4%; 9.8%; 2.8% Decrease in at least 1 anginal class: 81% overall Mean decrease in anginal episodes per week: 6.4±12.6 overall Decrease in use of nitroglycerin: 61.7% overall Overall, 11 patients (1.1%) withdrew due to a serious cardiac event. Clinical events were cited as the reason for discontinuing treatment in 43.8% of patients withdrawing. 15% of patients starting EECP treatment did not complete full course of treatment.
Holubkov et al., (57) 2002	Registry	2 cohorts: 1. IEPR, n=323 (PCI candidates at time of index EECP) 2. NHLBI, n=448 (patients who underwent PCI)	Mortality Patients’ self-reported level of exertional angina.	85.8% of EECP patients completed full course of treatment. 92.1% of PCI treated patients had a successful initial procedure. At 1 year, survival and rates of CABG were comparable, p=NS. IEPR patients reported more usage of Ca channel blockers [50.6% vs. 33.7%](p<0.001); angiotensin receptor blockers [5.6% vs. 1.9%](p<0.01); and long acting nitrates [53.0% vs. 30.3%](p<0.001). PCI registry patients reported using more short acting nitroglycerin [43.3% vs. 82.2%](p<0.001). Class III/IV or unstable symptoms were reported in 15.5% of EECP patients and 9.5% of PCI patients, p=0.02. 73.4% of PCI patients reported no angina after 1 year compared to IEPR patients (43.7%), p<0.001.
Lawson et al., (49)	Registry EECP Consortium	Cohort of 2,289 consecutive patients from 84 centres had completed follow-up. CCS I-IV.	Adverse effects Anginal class	91 adverse patient experiences were observed out of the entire patient registry (n=2,991). Overall, the average CCS class improved after EECP [average CCS class 2.78 vs. 1.81 p<0.001]. Pre EECP CCS IV (compared to CCS I and II) improvement: OR 3.30 (2.49-4.39), p<0.0001. PreEECP CCS III (compared to CCS I and II) improvement: OR 4.38 (3.46-5.56), p<0.0001. Patients receiving >35 hrs of treatment did not benefit more over the standard 35 hour course OR 1.02 (0.77-1.36).
Lawson et al., (50)	Case series	Single centre cohort of 33 consecutive angina patients followed for mean of 5 years.	Major adverse cardiovascular events (MACE)	In early post treatment: Radionuclide stress tests demonstrated a significant (p<0.01) improvement in perfusion defects in 26/33 (79%) of patients = responders. In the remaining 7 patients, stress tests were unchanged = nonresopnders. Over 5 years: 13/33 patients underwent additional EECP treatment.. 4 patients died, 9 patients experienced interim adverse events. 21/33 patients remained alive post therapy without cardiovascular morbidity or repeat revascularization.
Bonetti et al., (61) 2003	Case series	Single centre cohort of 23 patients.	Change in CCS functional class. DASI	17/23 (74%) improved 1+ CCS class and improved DASI score (maintained at 1 month followup).
Tartaglia et al., (62) 2003	Caser series	Single centre cohort of 25 patients.	Exercise duration (seconds) Significant change on ECG during ETT Change in CCS functional class.	Exercise duration: PreEECP 357 seconds; Post EECP 449 seconds; P<0.001. Of 16 patients with ST-segment depression preEECP, 10 (63%) had significant delay and 3 (19%) had no ST-segment depression post EECP. Reduction of 1+ angina class 24/25 (96%).
Werner et al., (63) 2003	Case series	Single centre cohort of 48 patients.	Symptom limited bicycle test (Watts) Symptom limited bicycle test (minutes) Angina count/week Nitroglycerin use/week	Symptom limited bicycle test: PreEECP 117.3 watts; PostEECP 137.8 watts; p<0.005. Symptom limited bicycle test: PreEECP 7.4 min; PostEECP 9.0 min; p<0.05. Angina count/week: PreEECP 6.4; PostEECP 3.3; p<0.05. Nitroglycerin use/week: PreEECP 5.5; PostEECP 2.7; p=Not significant.
Bagger et al., (64) 2004	Case series	Single centre cohort of 26 patients	CCS angina class (group mean) Exercise duration	CCS angina class: PreEECP 3.1; PostEECP 2.2; p<0.05. Exercise duration: Improved by 21% in the 78% who were able to perform the exercise test.
Michaels et al.,(42) 2004	Case series	Registry study. 1,097 patients from sites with >85% followup.	2 year followup Multiple clinical endpoints. Change in CCS class. Quality of life improvement (Likert scale).	Death 8.5% MI 8.9% Unstable angina 21.8% HF exacerbation 11.7% Cardiac hospitalization 39.3% Noncardiac hospitalization 40.9% Revascularization procedure 15% Repeat EECP 16.1% Event free 40.8% Change in CCS class: Among those event free, sustained reduction in CCS class at 2 years. Quality of Life: Improvement in 47% at 2 years.
Lawson et al. (65) 2005	Registry	N=2007 EECP patients completing at least 30 h of EECP, with 1 year follow-up and info on acute angina reduction	Determine predictors of 1-year angina status in patients who demonstrated initial clinical improvement (responders [R] vs. those who did not show benefit non-responders [NR] after EECP; anginal class, weekly anginal episodes, frequency of nitroglycerin use; quality of life	Angina reduced by at least 1 CCS class in 83% immediately post-EECP (1665), 17% no initial reduction (342). In R, weekly angina decreased from 10.4 to 1.7 (p<.001). NR sig. decrease from 11.5 to 5.8 (p<.05). Nitroglycerin use decreased in R from 9.3 – 1.6 (p<.001), but not significantly in the NR (10.5 – 8.0). QoL reported in 63% or R vs. 37% of NR. The only significant independent predictor of lack of initial response to EECP was baseline anginal class (I, II, III, versus IV with odds ratios 5.0, 4.8, 1.4 and CI 2.4 – 10.4, 3.2 – 7.0 and 1.0 – 2.0, respectively. At 1 year, 15% of NR vs. 8% of R had PCI or CABG (p<.0001).
Michaels et al. (66) 2005	Registry	N=1192 patients who completed a 1st course of EECP, and were enrolled in IEPR sites that provided >/=85% follow-up at 2 years; 90% had CCS class III or IV at baseline.	CCS class, angina episodes, nitroglycerin use	After initial course, 86% reported a decrease by at least 1 CCS class and nitroglycerin use discontinued by 57% of patients. Within 2 years post-EECP, 194 patients (18%) underwent a repeat EECP course of which 78% (152) had available data on 2nd course. Among repeaters, 70% demonstrated sig. decrease in angina, although distribution of CCS class not sig. different. At 2-year follow-up anginal symptoms remained sig. worse in patients who had repeat EECP (6 episodes per week in repeaters vs. 3 per week in non (p<.01), more nitroglycerin use in repeaters (63% vs. 45%, p<.001).
Lawson et al. (44) 2004	Registry	Patients divided into 3 groups: those without left main coronary artery disease (LMD; n=2,377), those with LMD and prior CABG (LMD-CABG) (n=431); and those with LMD and no prior CABG (LMD-NCABG (n=53)	CCS class Weekly angina episodes Weekly nitroglycerin use MACE	Post EECP improvements in CCS by at least one class in all three groups (NS between-group differences), No LMD (74%), LMD-CABG (75%), LMD-NCABG (65%). No between-group differences in mean decrease in weekly angina episodes (7.1 vs. 8.0 vs. 7.6) or frequency of weekly nitroglycerin use (6.6 vs. 8.1 vs. 8.9). At 6 month follow-up, CCS class further improved, and there was a further reduction in mean weekly angina episodes (4.7 vs. 4.6 vs. 5.3) and nitroglycerin use (6.5 vs. 6.8 vs. 8.2). MACE 8 months after EECP treatment was 11.2% in non-LMD, 15.6% in LMD with CABG, and 24.3% in LMD without CABG. Late mortality in LMD non-CABG was 13.2% (CI 3.3-23.1) versus 4.8% (CI 2.7 – 7.1) in LMD with CABG, and 2.8% (CI 2.1 – 3.5) without LMD.
Fitzgerald et al., (40) 2003	Registry	IEPR; N=4454 patients with prior CABG or PCI (CCS Class III/IV for 83.9%) compared with a group of patients (Pumpers, 77.2% Class II/III) who were candidates for either/both procedures but chose EECP as their initial revascularization treatment	Angina class; nitroglycerin use, angina episodes	Post-EECP a reduction by at least 1 CCS class was seen in 74.8% of Pumper vs. 72.7% non-pumper, p=NS. Decrease in angina episodes per week: 7.6% NP vs. 5.2 in pumpers, p<.001. Nitroglycerin use: 17.4% non-pumpers vs. 15.2% (5.9 times per week) pumpers, as compared to baseline of 71.4% (9.8 times per week) non-pumpers, 46.9 % (7.1 times per week) pumpers.
Lawson et al., (67) 2003	Registry	N=4592 patients with no prev. EECP treatment on enrollment in the IEPR registry; 82.3% in CCS class III or IV at baseline.	CCS functional class; angina frequency, nitroglycerin use, changes in medications, quality of life, interim MACE; Determination of patient characteristics which influence EECP success	83.1% completed prescribed EECP course. MACE over the course of therapy included death (.3%), MI (.9%), CABG (.2%), PCI (.8%), exacerbation of HF in 1.9%, unstable angina in 2.8%. CCS improvement of >/= 1 class in 73% of patients, >/=2 classes in 38.2%, >/=3 classes in 17.3% did not change in 26.0% and worsened in 1.1%. Mean angina episodes per week at baseline were 10.1 and decreased to 2.5 per week post EECP. Baseline nitroglycerin use was 9.5 times per week pre EECP, 2.5 times post-EECP. Overall success rate in patients with diabetes, prior CABG, and HF was 70% (success defined as 1 CCS class decrease).
Linnemeier et al.; (39) 2003	Registry	N=249 IEPR patients >/=80 years (elderly); Elderly more likely to be female, have a history of CHF (41% vs. 29%, p<.001), and less likely to have had prior revascularization (74% vs. 86%, p<.001); about 87% of elderly CCS Class III/IV pre-EECP, somewhat more severe than in younger (Class not reported).	MACE; cardiac hospitalization; angina frequency, nitroglycerin use; CCS class, Quality of Life,	Sig. fewer >/=80 years (elderly) completed treatment (76% versus 84%, p=.05); Treatment non-completion not stopped due to clinical event any more than in younger (11% versus 9%), rather, patient discontinued in 11% of elderly vs. 7% of non-elderly). At 6-month follow-up low rates of MACE in both groups NS except for death (8 in younger versus 6 in elderly (p=.05) and cardiac hospitalization, 12 in younger vs. 6 in elderly (p=.05). Very little change in medication use recorded, and NS between group differences. Sig, improvement post-EECP in patient-assessed QoL, health, and satisfaction (all p<.001).
Linnemeier et al., (41) 2003	Case series	N=1532 IEPR patients of which 665 (43%) reported a diagnosis of diabetes; patients with DM sig. more likely to have a history of heart failure	CCS class, MACE, angina episodes per week, nitroglycerin use, quality of life	In post-EECP period, MI (1.7% vs. .2%, p<.01) and HF (3.3% vs. 1.3%, p<.01) occurred sig. more often in the DM group. Post-EECP angina decreased by at least 1 CCS class in DM (69%) and ND (72%) of patients, diff.=NS. At 1 year, follow-up available for 86% of DM and 89.9% of ND; At 1-year, sig, increase in death (3.9% ND vs 7.5 % DM, p<.01), MACE (16.3% ND vs. 22.6% DM, p<.01, and CHF (6.1% ND vs. 12.8% DM, p<.001).