Enhanced external counterpulsation: A unique treatment for the “No‐Option” refractory angina patient

Abstract

What is known and objectives Coronary artery disease (CAD) is the leading cause of death in the United States. For patients on whom guideline‐driven measures have been tried, enhanced external counterpulsation (EECP) is the only truly noninvasive and safe intervention for which a reduction of angina symptoms and nitrate use, increased exercise tolerance, and improvement in myocardial ischaemia have been shown. The objective of this study was to demonstrate, by way of literature review, the efficacy of EECP as a treatment modality for the relief of refractory angina and improvement in quality of life in CAD patients. Methods This article reviewed the safety and efficacy of EECP in patients with refractory angina, by conducting a sweeping search and analysis of existing published literature. Results and Discussion Critical review of a multitude of studies revealed that EECP consistently reduces angina pectoris, extends time to exercise‐induced ischaemia, decreases dependency on nitroglycerine for frequent chest pain, increases maximum workload, and improves the quality of life in patients with symptomatic stable angina. The literature reviewed also indicated that EECP is well‐tolerated by the vast majority of patients, with relatively few adverse events reported. Conclusion The present study suggests that EECP is a safe and likely best available method of treatment for patients presenting with symptomatic CAD not amenable to further revascularization.

Predictors of adherence of enhanced external counterpulsation in patients with coronary heart disease after discharge: A mixed-methods study

“…The results of this study showed that the adherence rate of CHD patients to EECP treatment after discharge was only 24.23%, which was similar to the adherence to exercise training programs in cardiac rehabilitation (16,17). Studies have proved that adhering to a complete course of EECP treatment can not only improve the cardiac function of CHD patients, relieve the onset of angina, but also improve their sleep, anxiety, depression, and thus improve the quality of life (18)(19)(20)(21). However, the dropout rate of CHD patients after discharge was quite high in this study.…”

Reduction in risk of contrast-induced nephropathy in patients with chronic kidney disease and diabetes mellitus by enhanced external counterpulsation

“…Treatment with EECP is a safe, non-invasive extracorporeal circulation method that is widely used for cardiac-cerebral vascular diseases to reduce angina symptoms and the use of nitrates, increase exercise tolerance, and improve myocardial ischemia ( 18 ). It could also improve the quality of life of patients with cardiac failure ( 19 ), and have a positive effect on the hemodynamics of the coronary and carotid arteries ( 20 , 21 ).…”

Nonpharmacological interventions for ‘no-option’ refractory angina patients

“…Approximately 75% of patients are responders to EECP treatment, and these benefits are often sustained for from 3 to 5 years. [59][60][61] EECP is limited by a number of contraindications: coagulopathy with an international normal ratio of more than 2.5, arrhythmias, severe peripheral arterial disease, venous disease, and severe chronic obstructive pulmonary disease. 62 It is important to note that to the best of our knowledge, the majority of studies of EECP have investigated its use in stable angina rather than exclusively in RAP patients.…”