Enhanced External Counterpulsation for the Treatment of Angina With Nonobstructive Coronary Artery Disease

Namrita D Ashokprabhu; Jessie Fox; Timothy D Henry; Christian W Schmidt; Darlene Tierney; Julie Gallatin; Yulith Roca Alvarez; Lauren Thompson; Michelle Hamstra; Sachin A Shah; Odayme Quesada

doi:10.1016/j.amjcard.2023.10.061

Enhanced External Counterpulsation for the Treatment of Angina With Nonobstructive Coronary Artery Disease

Am J Cardiol. 2024 Jan 15:211:89-93. doi: 10.1016/j.amjcard.2023.10.061. Epub 2023 Oct 27.

Affiliations

¹ Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio; The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio.
² Flow Therapy, Fort Worth, Texas; Thomas J Long School of Pharmacy, University of the Pacific, Stockton, California.
³ The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio.
⁴ Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio.
⁵ Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio; The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio; Department of Medicine, University of Cincinnati, Cincinnati, Ohio. Electronic address: odayme.quesada@thechristhospital.com.

PMID: 37890564
DOI: 10.1016/j.amjcard.2023.10.061

Abstract

Angina and nonobstructive coronary artery disease (ANOCA) is associated with poor outcomes and limited treatment options. Enhanced external counterpulsation (EECP) is a noninvasive treatment that involves applying external inflatable cuffs to the lower extremities to increase blood flow during diastole, followed by deflation during systole. Although EECP is approved for treatment in patients with refractory angina due to obstructive coronary artery disease, its effectiveness in treating patients with ANOCA with refractory angina is limited to small studies. We assessed the efficacy of EECP treatment in patients with ANOCA (defined as ≤50% stenosis in any major epicardial vessels) with refractory anginaby measuring changes in Canadian Cardiovascular Society (CCS) angina class, 6-minute walk test, Duke Activity Status Index (DASI), Seattle Angina Questionnaire 7 (SAQ7), and weekly anginal episodes pre-EECP and post-EECP treatment. A total of 101 patients with ANOCA with CCS class III/IV angina completed a full course of EECP treatment at 2 large EECP centers. In 101 patients with ANOCA the mean age (SD) of 60.6 (11.3) years and 62.4% of the cohort were women. We found significant improvements post-EECP treatment in CCS angina class (mean (SD) 3.4 (0.5) to 2.4 (2.9), p <0.001), 6-minute walk test (median 1200 (IQR 972 to 1411) to 1358 (1170 to 1600), p <0.001), DASI (mean (SD) 15.2 (11.6) to 31.5 (16.3), p <0.001), SAQ7 (mean (DS) 36.2 (24.7) to 31.5 (16.3), p <0.001), and weekly anginal episodes (mean (SD) 5.3 (3.5) to 2.4 (2.9), p <0.001). After EECP treatment, 71 patients (70.3%) had an improvement of ≥1 CCS angina class, including 33 (32.7%) patients improving by ≥2 CCS classes. In conclusion, in patients with ANOCA, EECP therapy reduces CCS angina class and improves exercise tolerance and capacity; and should be considered a part of optimal medical therapy.

Keywords: ANOCA; EECP; angina and nonobstructive coronary artery disease; coronary microvascular dysfunction; enhanced external counter pulsation.

MeSH terms

Angina Pectoris
Canada
Coronary Artery Disease* / complications
Coronary Artery Disease* / therapy
Counterpulsation*
Female
Humans
Male
Middle Aged
Treatment Outcome