Document Detail


Residual high-grade angina after enhanced external counterpulsation therapy.
MedLine Citation:
PMID:  17765644     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We evaluated the degree of residual angina on the outcomes of enhanced external counterpulsation (EECP) therapy for chronic stable angina. BACKGROUND: Angina refractory to medical therapy is common in the pool of patients who are not completely revascularized by angioplasty or bypass surgery. METHODS: We examined 902 patients enrolled from 1998 to 2001 in the Second International Enhanced External Counterpulsation Patient Registry. Baseline and outcome variables were stratified by the last recorded Canadian Cardiovascular Society class. RESULTS: Residual Class 3 (12.1%) or 4 (2.3%) angina was uncommon among patients with severe coronary artery disease after treatment with EECP. Prevalence of diabetes, hypertension, dyslipidemia, and heart failure was similar among the anginal post-EECP anginal classes. Multivessel coronary disease was more common in those with higher-grade angina at completion. More frequent and severe angina at entry was more common in those with the higher anginal classes at EECP (P<.001). There were no differences in the rates of chronic medications utilized or prior revascularization. At 3-year follow-up, rates of death, myocardial infarction, percutaneous coronary intervention, and coronary artery bypass surgery tended to be higher across increasing residual angina classes. The composite cardiac event rates were 34%, 33%, and 44% for those with Class 0, Class 1/2, and Class 3/4 angina at EECP completion (P=.01), respectively. Multivariate analysis for the composite endpoint found residual Class 3/4 angina (OR=1.59, 95% CI=1.19-2.17, P=.002), diabetes (OR=1.57, 95% CI=1.23-2.01, P=.0003), age (per decile OR=1.17, 95% CI=1.04-1.31, P=.007), and greater EECP augmentation (OR=0.79, 95% CI=0.65-0.96, P=.02) as significant predictors. CONCLUSIONS: Residual high-grade angina after EECP occurs in those with more severe angina and multivessel disease at baseline and is associated with cardiac events over the next 3 years. These data suggest that close clinical observation and intensive management of those with high-grade angina post-EECP are warranted.
Authors:
Peter A McCullough; Timothy D Henry; Elizabeth D Kennard; Sheryl F Kelsey; Andrew D Michaels;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Cardiovascular revascularization medicine : including molecular interventions     Volume:  8     ISSN:  1553-8389     ISO Abbreviation:  -     Publication Date:    2007 Jul-Sep
Date Detail:
Created Date:  2007-09-03     Completed Date:  2007-11-01     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  101238551     Medline TA:  Cardiovasc Revasc Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  161-5     Citation Subset:  IM    
Affiliation:
Department of Medicine, Divisions of Cardiology, Nutrition and Preventive Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA. pmc975@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Angina Pectoris / drug therapy,  etiology*,  surgery
Angioplasty, Transluminal, Percutaneous Coronary
Chronic Disease
Coronary Artery Bypass
Coronary Artery Disease / complications,  drug therapy,  mortality,  surgery*
Counterpulsation / adverse effects,  methods*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Infarction / etiology,  mortality
Odds Ratio
Recurrence
Registries
Reoperation
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
Vasodilator Agents / therapeutic use
Chemical
Reg. No./Substance:
0/Vasodilator Agents

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