title: Two-year clinical outcomes after enhanced external counterpulsation (EECP) therapy in patients with refractory angina pectoris and left ventricular dysfunction (report from The International EECP Patient Registry).
abstract: Enhanced external counterpulsation (EECP) is a noninvasive circulatory assist device that has recently emerged as a treatment option for refractory angina in left ventricular (LV) dysfunction. This 2-year cohort study describes the long-term follow-up of patients who had severe LV dysfunction that was treated with EECP for angina pectoris and reports clinical outcomes, event-free survival rates, and the incidence of repeat EECP. This study included 363 patients who had refractory angina and LV ejection fraction < or =35%. Most patients reported quality of life as poor. After completion of treatment, there was a significant decrease in severity of angina class (p < 0.001), and 72% improved from severe angina to no angina or mild angina. Fifty-two percent of patients discontinued nitroglycerin use. Quality of life improved substantially. At 2 years this decrease in angina was maintained in 55% of patients. The 2-year survival rate was 83%, and the major adverse cardiovascular event-free survival rate was 70%. Forty-three percent had no reported cardiac hospitalization; 81% had no reported congestive heart failure events. Repeat EECP was performed in 20% of these patients. The only significant independent predictor of repeat EECP in a proportional hazard model was failure to complete the first EECP treatment course (hazard ratio 2.9, 95% confidence interval 1.7 to 4.9). Improvements in angina symptoms and quality of life were maintained at 2 years. In conclusion, for patients who have high-risk LV dysfunction, EECP offers an effective, durable therapeutic approach for refractory angina. Decreased angina and improvement in quality of life were maintained at 2 years, with modest repeat EECP and low major cardiovascular event rates.
authors.affiliation: Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. soranzo@upmc.edu
authors.forename: Ozlem
authors.initials: O
authors.lastname: Soran
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Kennard
authors.forename: Abdallah Georges
authors.initials: AG
authors.lastname: Kfoury
authors.forename: Sheryl F
authors.initials: SF
authors.lastname: Kelsey
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000453:epidemiology; D015908:Counterpulsation; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D011788:Quality of Life; D012042:Registries; D019233:Retreatment / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000706:statistics & numerical data; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000628:therapy*