Abstract 15742: Long Term Clinical Outcomes and Major Adverse Cardiac Event Rates of Enhanced External Counterpulsation Therapy in the Real World Settings in Patients with Coronary Artery Disease and Left Ventricular Dysfunction
Objectives: Enhanced external counterpulsation (EECP) is a noninvasive circulatory assist device that has recently emerged as a treatment option for refractory angina in left ventricular dysfunction (LVD). The aim of this study is to assess the long term clinical outcomes and the incidence of repeat EECP therapy in patients with refractory angina and LVD in the real world settings without applying inclusion and exclusion criteria.
Methods: The International EECP patient registry (IEPR phase I and II) was initiated at the University of Pittsburgh and enrolled patients from 139 sites, mostly from US and Europe, and tracked the outcomes of patients for 2 years who had undergone EECP treatment for angina. Angina status and quality of life (QoL) were assessed. Major adverse cardiac events (MACE) were specified as the composite of death, myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting.
Results: Data from 1276 patients with LVD (EF<40) were analyzed; 88% had multivessel disease and 92% were not candidates for further revascularization. Mean EF was 30.67% ±8.3. Angina was severe (Canadian Cardiovascular Society class III/IV) in 94% of patients. Most patients reported QoL as poor. On average, patients underwent an EECP treatment course of 32 hours, with 79% completing the therapy. Five percent discontinued due to a clinical event, and 6% stopped due to patient preference. After completion of treatment, there was a significant decrease in severity of angina class (p <0.001), and 75% had angina reduction at least one class; 47% discontinued nitroglycerin use; QoL improved substantially. At 2 years this decrease in angina was maintained in 74% of patients. The 2-year survival rate was 83%, the MACE free survival rate was 69% and the repeat EECP rate was 17%.
Conclusion: The results showed that EECP offers an effective, long term treatment for angina pectoris management in patients with LVD, with modest repeat EECP and low major cardiovascular event rates in the real world settings.
- © 2011 by American Heart Association, Inc.