title: Enhanced external counterpulsation in the treatment of chronic refractory angina: a long-term follow-up outcome from the International Enhanced External Counterpulsation Patient Registry.
abstract: BACKGROUND
  The management of patients who suffer from medically refractory angina and are unsuitable for conventional revascularization therapy is often unsatisfactory. Enhanced external counterpulsation (EECP) is a noninvasive treatment that is safe and effective immediately after a course of treatment. However, the duration of benefit is less certain.
  
  
  OBJECTIVE
  To evaluate the 3-year outcome of EECP treatment.
  
  
  METHODS
  One thousand four hundred and twenty seven patients from 36 centers registered in the International EECP Patient Registry (IEPR)-Phase 1 was prospectively followed for a median of 37 months. Two hundred and twenty patients (15.4%) died, while 1,061 patients (74.4%) completed their follow-up.
  
  
  RESULTS
  The mean age was 66+/-11 years and 72% were men. Seventy-six percent had multivessel coronary disease for 11+/-8 years. Eighty-eight percent had a prior percutaneous or surgical revascularization and 82% were unsuitable for further coronary intervention. Immediately post-EECP, the proportion of patients with severe angina (Canadian Cardiovascular Angina Classification [CCS] III/IV) were reduced from 89% to 25%, p<0.001. The CCS class was improved by at least 1 class in 78% of the patients and by at least 2 classes in 38%. This was sustained in 74% of the patients during follow-up.Thirty-six percent of the patients had CCS II or less angina, which was better than pre-EECP state without a major adverse cardiovascular event during follow-up. More severe baseline angina and a history of heart failure or diabetes were independent predictors of unfavorable outcome.
  
  
  CONCLUSIONS
  An EECP improves angina and quality of life immediately after a course of treatment. For most of the patients, these beneficial effects are sustained for 3 years.
authors.affiliation: Department of Academic Cardiology, University of Hull, Hull Royal Infirmary, and Department of Cardiology, Hull Hospital NHS Trust, Hull, UK. huan.loh@hey.nhs.uk
authors.forename: Poay Huan
authors.initials: PH
authors.lastname: Loh
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
authors.forename: Amal A
authors.initials: AA
authors.lastname: Louis
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Kennard
authors.forename: Jocelyn F
authors.initials: JF
authors.lastname: Cook
authors.forename: John L
authors.initials: JL
authors.lastname: Caplin
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Barsness
authors.forename: William E
authors.initials: WE
authors.lastname: Lawson
authors.forename: Ozlem Z
authors.initials: OZ
authors.lastname: Soran
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Michaels
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000503:physiopathology / Q000628:therapy*; D015908:Counterpulsation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life