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

• Published in: Heart (British Cardiac Society) Vol. 82; no. 1; pp. 82 - 88
• Main Authors: TenVaarwerk, I A M, Jessurun, G A J, DeJongste, M J L, Andersen, C, Mannheimer, C, Eliasson, T, Tadema, W, Staal, M J
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01-07-1999; BMJ; BMJ Publishing Group LTD
• Subjects: Angina pectoris; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Clinical outcomes; Coronary heart disease; Heart; Heart attacks; Medical sciences; Mortality; pain; Spinal cord; spinal cord stimulation; Human; Refractory; Instrumental stimulation; Spinal cord; Prognosis; Treatment; Follow up study; Electrical stimulus; Cardiovascular disease; Angina pectoris; Coronary heart disease; Survival
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.82.1.82

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, β blocking agents, and angiotensin converting enzyme inhibitors. Multiple variate analysis showed that LVEF, sex, β 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 affected by the chronic use of neurostimulation.