title: Effect of spinal cord stimulation on spontaneous and stress-induced angina and 'ischemia-like' ST-segment depression in patients with cardiac syndrome X.
abstract: OBJECTIVE
  A significant number of patients with cardiac syndrome X (CSX) present frequent episodes of severe chest pain, refractory to maximal multi-drug therapy. A few, small, uncontrolled data suggested that spinal cord stimulation (SCS) may have favourable clinical benefits in these patients.
  
  
  RESULTS
  We studied 10 CSX patients who were being treated by SCS for refractory angina pectoris for 17+/-16 months (median 8). Patients were randomized to either continue or withdraw SCS for a period of 3 weeks and were then crossed over to the other condition for a further 3-week period. During each 3-week period patients kept a detailed diary of angina episodes occurring in the last 2 weeks of each phase. Furthermore, at the end of each 3-week period, angina status was also assessed by Seattle Angina Questionnaire (SAQ), a 0-100 visual analogue scale (VAS), and patients underwent 24-h Holter monitoring (HM) and echocardiographic dobutamine stress test (DST). Compared with the withdrawal phase, SCS reduced the number (P=0.01), duration (P=0.022), and severity (P=0.011) of angina episodes, and nitrate consumption (P=0.042). SAQ scores (P< or =0.013 for all) and VAS (P<0.001) were also improved, the number of episodes of ST-segment depression on HM was decreased (P=0.014), and time to angina (P=0.045) and to 1 mm ST-segment depression (P=0.04) during DST were both prolonged by SCS.
  
  
  CONCLUSIONS
  Our data point out that SCS may be an effective form of treatment in patients with CSX suffering from frequent angina episodes significantly impairing quality of life (QOL) and refractory to maximally tolerated drug therapy.
authors.affiliation: Istituto di Cardiologia, Università Cattolica del Sacro Cuore, L. go A. Gemelli, 8, 00168 Roma, Italy. g.a.lanza@inwind.it
authors.forename: Gaetano A
authors.initials: GA
authors.lastname: Lanza
authors.forename: Alfonso
authors.initials: A
authors.lastname: Sestito
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Sgueglia
authors.forename: Fabio
authors.initials: F
authors.lastname: Infusino
authors.forename: Fabio
authors.initials: F
authors.lastname: Papacci
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Visocchi
authors.forename: Carolina
authors.initials: C
authors.lastname: Ierardi
authors.forename: Mario
authors.initials: M
authors.lastname: Meglio
authors.forename: Fulvio
authors.initials: F
authors.lastname: Bellocci
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002908:Chronic Disease; D018592:Cross-Over Studies; D025401:Echocardiography, Stress; D004599:Electric Stimulation Therapy / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D017566:Microvascular Angina / Q000503:physiopathology / Q000628:therapy; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D011788:Quality of Life; D013116:Spinal Cord