title: Spinal cord stimulation for patients with refractory angina and previous coronary surgery.
abstract: BACKGROUND
  Refractory angina pectoris is an exceptionally debilitating condition affecting patients who have typically failed multiple percutaneous and surgical revascularizations and optimal medical therapy and who are not amenable for further revascularization procedures. Spinal cord stimulation (SCS) has been adopted in this context at our institution and midterm mortality, anginal status, and quality of life have been evaluated.
  
  
  METHODS
  From 1998 to 2004, 51 patients with refractory class III-IV angina, who were not considered candidates for revascularization procedures, underwent SCS. All patients had already undergone previous surgical revascularization and a median of two percutaneous procedures. Transmyocardial laser revascularization had been previously performed in 8 cases (15.6%). Most of the patients (70.5%) had experienced a myocardial infarction. Mean ejection fraction was 0.42 +/- 0.121, Canadian Cardiovascular Society class 3.5 +/- 0.5, quality of life (Spitzer index) 4.5 +/- 1.2, and the median frequency of weekly angina episodes was 10.
  
  
  RESULTS
  There were no SCS implantation-related complications. At follow-up (100% complete, mean 24 +/- 18 months), a significant improvement of anginal symptoms (>50% reduction of weekly anginal episodes) occurred in 45 patients (88.2%). In those patients (Responders), the quality of life improved significantly (6.8 +/- 1.5; p < 0.0001), CCS class decreased to 2 +/- 0.7 (p < 0.0001), and the median frequency of weekly angina episodes to 3 (p < 0.0001). At 3 years, Responders' survival was 91.8 +/- 4.6% and the freedom from cardiac events 72.6 +/- 8.42%.
  
  
  CONCLUSIONS
  Spinal cord stimulation is a safe and effective procedure in truly no-option patients affected by refractory angina. A midterm sustained improvement of symptoms and quality of life have been documented with a satisfactory 3-year survival rate.
authors.affiliation: Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy. lapenna.elisabetta@hsr.it
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Lapenna
authors.forename: Dino
authors.initials: D
authors.lastname: Rapati
authors.forename: Paola
authors.initials: P
authors.lastname: Cardano
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.forename: Francesca
authors.initials: F
authors.lastname: Lullo
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D002317:Cardiovascular Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D013116:Spinal Cord; D016019:Survival Analysis
chemical_list: D002317:Cardiovascular Agents