title: Comparison of long term clinical outcomes, event free survival rates of patients undergoing enhanced external counterpulsation for coronary artery disease in the United States and Turkey.
abstract: OBJECTIVE
  This study assessed the long-term efficacy of EECP (Enhanced External Counterpulsation) in Turkish (TR) patients initially and compared these results with the United States (US) in a real world setting.
  
  
  METHODS
  In this study, 2072 patients were treated and followed in the US and 82 patients were treated and followed in TR. The International EECP Patient Registry Phase I and II was initiated and coordinated at the University of Pittsburgh. The aim of the "registry" was to assess the outcomes of clinical trials in a real world setting. Another unique feature of this study was to enroll patients not only from university hospitals but also from private hospitals, educational hospitals, and treatment centers.
  
  
  RESULTS
  TR patients had less diabetes, hypertension, and hyperlipidemia than US patients (p<0.01). TR patients also had a higher proportion of diastolic augmentation (p<0.001). Both groups showed a significant reduction in the severity of angina after a 35 h EECP course (p<0.001). Major Adverse Cardiac Events (MACE) rate (death, coronary artery bypass graft, percutaneous coronary intervention, myocardial infarction) was low in both groups during treatment (2.5% vs. 2.7%). At 1 year follow up, 84% of TR and 76% of US patients had maintained the improvement of angina.
  
  
  CONCLUSIONS
  Patients presenting for EECP treatment from TR had different baseline profiles from US patients. However, despite the high risk baseline characteristics, both cohorts achieved similar reduction in angina. In the long term follow-up, the MACE rate was low and the improvement after EECP was sustained in most of the patients.
authors.affiliation: Department of Cardiology, University of Pittsburgh, Heart and Vascular Institute, PA, USA. soranzo@upmc.edu
authors.forename: Ozlem
authors.initials: O
authors.lastname: Soran
authors.forename: Coşkun
authors.initials: C
authors.lastname: Ikizler
authors.forename: Atilla
authors.initials: A
authors.lastname: Sengül
authors.forename: Bilal
authors.initials: B
authors.lastname: Cuğlan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kennard
authors.forename: Sheryl
authors.initials: S
authors.lastname: Kelsey
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D015908:Counterpulsation / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D017741:Survivors / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D014481:United States / Q000453:epidemiology