Clinical outcome of patients treated with spinal cord stimulation for therapeutically refractory angina pectoris

Abstract

Objective-To determine morbidity and mortality characteristics in patients treated with electrical neuromodulation for refractory angina pectoris. Design-A retrospective multicentre study of patients treated with spinal cord stimulation between 1987 and 1997; 21 centres were contacted and 14 responded. Setting-Specialist centres worldwide. Patients-Questionnaires were returned on 517 patients, of whom 71% were male. One was lost to follow up. Mean (SD) age was 63.9 (10.1) years. Duration of angina pectoris was 8.1 (6.3) years. Results-Before spinal cord stimulation, 66% of the patients had experienced myocardial infarction, 68% had three vessel disease, and in 24% the left ventricular ejection fraction (LVEF) was < 40%. Percutaneous transluminal coronary angioplasty and bypass surgery were performed in 17% and 58% of the subjects, respectively. During a median follow up of 23 months (range 0 to 128), 103 patients died (52 from a cardiac cause, 25 from a non-cardiac cause, and 26 from an unknown cause). Annual all cause mortality was 7-8%; annual cardiovascular fatality was 3.5-5%. Mortality was univariately related to sex, number of diseased vessels, number of revascularisation procedures, previous myocardial infarction, LVEF, insulin dependent diabetes, blocking agents, and angiotensin converting enzyme inhibitors. Multiple variate analysis showed that LVEF, sex, blockers, and age > 71 years were independent predictors of mortality. During spinal cord stimulation, New York Heart Association functional class improved from 3.5 to 2.1 (p < 0.01); 25 of the deceased patients (24%) and 32 survivors (8%) experienced myocardial infarction; hospital admissions were significantly (p < 0.001) more common in the deceased group (66% v 37%). Conclusions-The clinical outcome of patients with intractable angina is not adversely aVected by the chronic use of neurostimulation. (Heart 1999;82:82-88)

Effective treatment of symptomatic diabetic polyneuropathy by high-frequency external muscle stimulation

“…We applied 1-s frequencies of 4,096-32,768 Hz, introducing up to 5,000 mW into the muscles. High-frequency electrical spinal cord stimulation with implanted electrodes has previously been shown to be effective in the relief of chronic diabetic neuropathic pain [8] and several other chronic painful conditions, including back pain, phantom-limb pain, peripheral vascular disease and severe angina [19,20]. Whereas this procedure is not free of risk and may give rise to life-threatening infection [21], the HF treatment used in our study is safe and may potentially be used for other chronic pain indications.…”

ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina—Summary Article

“…29 Another small randomized trial involved 24 patients with refractory angina. 30 Nine other studies, either retrospective [31][32][33] or prospective 29,34 -38 cohort studies, were identified in the literature. Although the results of these studies appear promising, there is still a paucity of data on the intermediateand long-term benefit of these devices.…”

Spinal cord stimulation in the treatment of neuropathic pain: Current perspectives of indications, cost-effectiveness, complications and results

“…Furthermore, this also applies to the improvement of the quality of life, enhancement of physical performance, reduction in the use of nitroglycerine, decrease in hospitalization admissions, and reduction in pain intensity and frequency in these patients. With this regard, in 1999, Vaarwerk et al (62) presented the results of the SCS use in patients (n = 517) diagnosed with refractory angina pectoris. The study included 71% male patients (n = 367), a median follow-up was 23 months (ranging from 0 to 128), within the mean age 63.9±10.1 years.…”