title: [Spinal cord stimulation for refractory chronic angina pectoris: 100 patients treated in our 12-year experience].
abstract: BACKGROUND
  The aim of this study was to evaluate the quality of life (QoL) benefit of patients with chronic refractory angina treated with spinal cord stimulation (SCS) in our experience.
  
  
  METHODS
  Between February 1998 and August 2010, 100 patients with chronic refractory angina who could not benefit from myocardial revascularization underwent SCS at the San Raffaele Scientific Institute of Milan (Italy). All patients were prospectively followed up at our outpatient clinic. The Spitzer index was used to evaluate QoL of patients before the procedure and at follow-up.
  
  
  RESULTS
  Mean age was 66 ± 8 years (range 46-79). Ninety-four patients (94%) were in CCS class III-IV (mean CCS class 3.5 ± 0.1) and 62 patients (62%) were in NYHA class III-IV (mean NYHA class 2.6 ± 0.1). The preoperative Spitzer index was 4.4 ± 1.4. Mean angina episodes per week were 12.6 ± 9.3 and mean consumption of sublingual nitrates was 11.0 ± 9.4. At follow-up, overall mortality was 11% (n = 11), and cardiovascular death was 3%. A reduction in angina episodes per week >50% was observed in 88% of patients (from 12.6 ± 9.3 to 2.7 ± 1.13; p<0.0001). Mean consumption of sublingual nitrates decreased from 11.0 ± 9.4 to 2.3 ± 0.1 (p<0.0001). The Spitzer index significantly improved (from 4.4 ± 0.1 to 2.3 ± 0.1; p<0.0001). NYHA class and CCS class decreased from 2.6 ± 0.1 to 2.0 ± 0.1 and from 3.5 ± 0.1 to 1.7 ± 0.1, respectively (both p<0.0001).
  
  
  CONCLUSIONS
  SCS is an effective and safe therapeutic option for patients with chronic refractory angina and it is associated with improved functional status and QoL at follow-up.
authors: Dipartimento di Chirurgia Cardio-Toraco-Vascolare, Ospedale Universitario San Raffaele, Milano. fumero.andrea@hsr.it
authors: Andrea
authors: A
authors: Fumero
authors: Elisabetta
authors: E
authors: Lapenna
authors: Maurizio
authors: M
authors: Taramasso
authors: Ottavio
authors: O
authors: Alfieri
mesh_terms: D000368:Aged; D000465:Algorithms; D000787:Angina Pectoris / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002908:Chronic Disease; D004599:Electric Stimulation Therapy / Q000379:methods; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage; D017060:Patient Satisfaction; D018579:Patient Selection; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D013116:Spinal Cord / Q000503:physiopathology; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin