Abstract
Background 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.
Methods: 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 of residual 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 ≥ 70% luminal diameter narrowing. Benefit was assessed by improvement in postEECP treatment over pretreatment radionuclide stress testing.
Results: Radionuclide stress testing demonstrated a comparable favorable response (80 vs. 71 %; 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 single‐and double‐vessel CAD (88 vs. 80%; p = NS). Most notably, CABG significantly increased the beneficial response to EECP in those patients with triple‐vessel CAD and stenotic grafts compared with unrevascularized patients with triplevessel CAD (80 vs. 22%; p < 0.05 by chi‐square test).
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.
Keywords: external counterpulsation, coronary artery disease, revascularization, coronary artery bypass grafting
Full Text
The Full Text of this article is available as a PDF (359.2 KB).
References
- 1. 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]
- 2. 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]
- 3. 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]
- 4. Lawson WE, Hui J, Burger L, Cohn PF: Five year follow‐up of morbidity and mortality in 33 angina patients treated with enhanced external counterpulsation(abstr). J Invest Med 1997; 45: 212A [Google Scholar]
- 5. Lawson WE, Hui JCK, Zheng ZS, Burger L, Jiang L, Lillis O, SorotT HS, Cohn PF: Can angiographic findings predict which coronary patients will benefit from enhanced external counterpulsaiion? Am J Cardiol 1996; 77: 1107–1109 [DOI] [PubMed] [Google Scholar]
- 6. Kern MJ. Aguirre FV, Talineni 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]
- 7. Kern MJ. Aguirre F, Bach R, Donohue T. Siegel R. Segal J: Augmentation of coronary blood flow by intra‐aortic blood flow by intra‐aortic balloon pumping in patients after coronary angioplasty. Circulation 1993; 87: 500–511 [DOI] [PubMed] [Google Scholar]
- 8. Lawson WE, Hui JCK, Oster ZH, Zheng ZS, Cabahug C. Kalz 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]
- 9. Lawson WE, Hui JCK, Burger L, Guo T, Oster Z, Katz J, Cohn PF: Triple vessel disease patients benefit from enhanced external counterpulsation despite stenotic grafts. J Invest Med 1997; 45: 214A [Google Scholar]
- 10. Lawson WE, Hui JCK, Zheng ZS, Burger L, Guo T, Soroff H, Cohn PF: Does prior myocardial revascularization predict which patients will benefit most from enhanced external counterpulsation? (abstr). J Invest Med 1997; 45: 214A [Google Scholar]