Prior revascularization increases the effectiveness of enhanced external counterpulsation

• Published in: Clinical cardiology (Mahwah, N.J.) N.J.), 1998-11, Vol.21 (11), p.841-844
• Main Authors: Lawson, William E., Hui, John C.K., Guo, Tong, Burger, Lynn, Cohn, Peter F.
• Format: Article
• Language: English
• Subjects: Aged; Angina Pectoris - diagnostic imaging; Angina Pectoris - therapy; Biological and medical sciences; Chronic Disease; Clinical Investigation; Clinical Investigations; Coronary Artery Bypass; coronary artery bypass grafting; coronary artery disease; Coronary Disease - diagnostic imaging; Coronary Disease - surgery; Coronary Disease - therapy; Counterpulsation; Exercise Test; external counterpulsation; Female; Humans; Male; Medical sciences; Middle Aged; Radionuclide Imaging; revascularization; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.4960211111

Background and hypothesis: Enhanced external counterpulsation (EECP) is an effective noninvasive treatment for chronic angina. However, its usefulness has been felt to be limited in patients with angiographically demonstrated triplevessel coronary artery disease (CAD), in accord with the hypothesis that a patent vessel is necessary for transmission of the EECP‐augmented coronary artery pressure and volume to the distal coronary vasculature. Methods: The effect of revascularization [coronary artery bypass grafting (CABG)] prior to EECP was examined in 60 patients with CAD and chronic angina (35 without and 25 with prior CABG). Patients were grouped by the extent of CAD (single‐, double‐, triple‐vessel disease in the unrevascularized group) and by the extent of residual disease (number of stenotic native vessels unbypassed or supplied by a stenotic graft in the CABG group). Significant CAD or graft stenoses were defined as stenoses demonstrating ≥ 70% luminal diameter narrowing. Benefit was assessed by improvement in postEECP treatment over pretreatment radionuclide stress testing. Results: Radionuclide stress testing demonstrated a comparable favorable response (80 vs. 71 %; p = NS) in patients with prior CABG versus unrevascularized patients. Enhanced external counterpulsation was highly and comparably effective in patients with unrevascularized native single‐ and double‐vessel CAD and in patients with CABG with residual single‐and double‐vessel CAD (88 vs. 80%; p = NS). Most notably, CABG significantly increased the beneficial response to EECP in those patients with triple‐vessel CAD and stenotic grafts compared with unrevascularized patients with triplevessel CAD (80 vs. 22%; p < 0.05 by chi‐square test). Conclusion: The results suggest a new role for EECP as an effective treatment for post CABG ischemia, despite extensive CAD and even in the presence of stenotic grafts.