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 and/or 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 61% who had undergone either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA), 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 PTCA (6), valve replacement (1), unstable angina (1)]. Nonresponders had significantly (p <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.
Keywords: coronary artery disease, external counterpulsation, prognosis
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References
- 1. Kantrowitz A, Kantrowitz A: Experimental augmentation of coronary flow by retardation of arterial pulse pressure. Surgery 1953; 34: 678–687 [PubMed] [Google Scholar]
- 2. Soroff HS, Hui J, Giron F: Current status of counterpulsation. Crit Care Clin 1986; 2: 277–295 [PubMed] [Google Scholar]
- 3. Lawson WE, Hui JCK, Soroff HS, Zheng ZS, Kayden DS, Sasvary D, Atkins H, Cohn PF: Efficacy of enhanced external counterpulsation in the treatment of angina pectoris. Am J Cardiol 1992; 70: 859–862 [DOI] [PubMed] [Google Scholar]
- 4. Lawson WE, Hui JCK, Zheng ZS, Burger L, Jiang L, Lillis O, Oster Z, Soroff H, Cohn PF: Improved exercise tolerance following enhanced external counterpulsation: Cardiac or peripheral effect? Cardiology 1996; 87: 1–5 [DOI] [PubMed] [Google Scholar]
- 5. Lawson, WE , Hui JCK, Guo T, Burger L, Cohn PF: Prior revascularization increases the effectiveness of enhanced external counterpulsation. Clin Cardiol 1998; 21: 841–844 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Lawson WE, Hui JCK, Oster ZH, Zheng ZS, Cabahug C, Katz JP, Dervan JP, Burger L, Jiang L, Soroff HS, Cohn PF: Enhanced external counterpulsation as an adjunct to revascularization in unstable angina. Clin Cardiol 1997; 20: 178–180 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Kern MJ, Aguirre FV, Tatineni S, Penick D, Serota H, Donohue T, Salter K: Enhanced coronary blood flow velocity during intra‐aortic balloon counterpulsation in critically ill patients. J Am Coll Cardiol 1993; 21: 359–368 [DOI] [PubMed] [Google Scholar]
- 8. Kern MJ, Aguirre F, Bach R, Conohue T, Siegel R, Segal J: Augmentation of coronary blood flow by intra‐aortic balloon pumping in patients after coronary angioplasty. Circulation 1993; 87: 500–511 [DOI] [PubMed] [Google Scholar]
- 9. Lawson WE, Hui JCK, Zheng ZS, Oster Z, Katz JP, Diggs P, Burger L, Cohn CD, Soroff HS, Cohn PF: Three‐year sustained benefit from enhanced external counterpulsation in chronic angina pectoris. Am J Cardiol 1995; 75: 840–841 [DOI] [PubMed] [Google Scholar]
- 10. Arora RR, Chou TM, Jain D, Nesto RW, Fleischman B, Crawford L, McKiernan T: Results of the Multicenter Study of Enhanced External Counterpulsation (MUST‐EECP): EECP reduces anginal episodes and exercise‐induced myocardial ischemia. Circulation 1997; 96 (8): I–466 (2602) [DOI] [PubMed] [Google Scholar]
- 11. Arora RR, Chou TM, Jain D, Nesto RW, Fleischman B, Crawford L, McKiernan T: Results of the Multicenter Enhanced External Counterpulsation (MUST‐EECP) outcomes study: Quality of life benefits sustained six months after treatment. Circulation 1998; 98 (suppl I): I–350 (1838) [Google Scholar]
- 12. Emond M, Mock MB, Davis KJ, Fisher LD, Holmes DR Jr, Chaitman BR, Kaiser GC, Alderman E, Killip T III, and Participants in the Coronary Artery Surgery Study (CASS) : Long‐term survival of medically treated patients in the Coronary Artery Surgery Study (CASS) registry. Circulation 1994; 90: 2645–2657 [DOI] [PubMed] [Google Scholar]
- 13. Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, Davis K, Killip T, Passamani E, Norris R, Morris C, Mathur V, Varnauskas E, Chalmers TC: Effect of coronary artery bypass graft surgery on survival: Overview of 10‐year results from randomized trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet 1994; 344: 563–570 [DOI] [PubMed] [Google Scholar]
- 14. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators : Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med 1996; 335: 217–225 [DOI] [PubMed] [Google Scholar]