title: Immediate and long-term clinical outcome after spinal cord stimulation for refractory stable angina pectoris.
abstract: The treatment of patients with angina pectoris refractory to medical therapy and unsuitable for revascularization procedures has yet not been well standardized. Previous retrospective studies and small prospective studies have suggested beneficial effects of spinal cord stimulation (SCS) in these patients. We created a Prospective Italian Registry of SCS to evaluate the short- and long-term clinical outcome of patients who underwent SCS device implantation because of severe refractory angina pectoris. Overall, 104 patients were enrolled in the registry (70 men, aged 68 +/- 17 years), most of whom (83%) had severe coronary artery disease. Average follow-up was 13.2 +/- 8 months. Overall, 17 patients (16%) died, 8 (8%) due to cardiac death. Among clinical variables, only age was found to be significantly associated both with total mortality (p = 0.04) and cardiac mortality (p = 0.02) on Cox regression analysis. A significant improvement of anginal symptoms (> or =50% reduction of weekly anginal episodes, compared with baseline) occurred in 73% of patients, and Canadian Cardiovascular Society angina class improved by > or =1 class in 80% and by > or =2 classes in 42% of patients, with a relevant reduction in the rate of hospital admission and days spent in the hospital because of angina (p <0.0001 for both). No life-threatening or clinically serious complications were observed. The most frequent side effect consisted of superficial infections, either at the site of puncture of electrode insertion or of the abdominal pocket, which occurred in 6 patients. In conclusion, our prospective data point out that SCS can be performed safely and is associated with a sustained improvement of anginal symptoms in a relevant number of patients with refractory stable angina pectoris.
authors.affiliation: Ospedale Umberto I, Mestre, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Pede
authors.forename: Gaetano Antonio
authors.initials: GA
authors.lastname: Lanza
authors.forename: Guerrino
authors.initials: G
authors.lastname: Zuin
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.forename: Massimo
authors.initials: M
authors.lastname: Rapati
authors.forename: Massimo
authors.initials: M
authors.lastname: Romanò
authors.forename: Antonio
authors.initials: A
authors.lastname: Circo
authors.forename: Paola
authors.initials: P
authors.lastname: Cardano
authors.forename: Fulvio
authors.initials: F
authors.lastname: Bellocci
authors.forename: Massimo
authors.initials: M
authors.lastname: Santini
authors.forename: Attilio
authors.initials: A
authors.lastname: Maseri
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000401:mortality / Q000628:therapy*; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012042:Registries; D012044:Regression Analysis; D013116:Spinal Cord / Q000502:physiology*; D016896:Treatment Outcome