Linnemeier Georgiann, Rutter Martin K, Barsness Gregory, Kennard Elizabeth D, Nesto Richard W
HeartGen Center, Indianapolis, Ind, USA.
Am Heart J. 2003 Sep;146(3):453-8. doi: 10.1016/S0002-8703(03)00251-5.
Patients with diabetes are at greater risk for coronary events, yet they are less likely to benefit from revascularization than those without diabetes. Enhanced external counterpulsation has recently emerged as a treatment option for select patients with chronic stable angina.
We examined baseline characteristics, angina response, and cardiac outcomes of patients with diabetes mellitus treated with Enhanced External Counterpulsation (EECP) for chronic stable angina. Data were collected from patients enrolled in the International EECP Patient Registry (IEPR) before and after a course of EECP, and at 1 year after completion of treatment.
Of 1532 IEPR patients studied, 43% had diabetes mellitus at baseline. Patients with diabetes were experiencing, on average, 11 episodes of angina per week. Most had been revascularized with prior percutaneous coronary intervention or coronary artery bypass graft surgery (86%) and most were considered unsuitable for either additional procedure (87%). Treatment was completed as prescribed in 79% of patients (mean, 32 hours). Immediately after EECP, 69% of patients with diabetes demonstrated a reduction in angina of > or =1 Canadian Cardiovascular Society angina class. After 1 year, maintenance of angina reduction was reported in 72% of patients with diabetes. Quality of life was significantly improved. Despite a high-risk profile among the diabetic group in this study, 1-year mortality was similar to coronary intervention registry populations.
This study suggests that in select patients with diabetes, EECP can be a safe, effective, well-tolerated treatment option for the relief of angina.
糖尿病患者发生冠状动脉事件的风险更高，但与非糖尿病患者相比，他们从血运重建中获益的可能性较小。增强型体外反搏最近已成为某些慢性稳定型心绞痛患者的一种治疗选择。
我们研究了接受增强型体外反搏（EECP）治疗慢性稳定型心绞痛的糖尿病患者的基线特征、心绞痛反应和心脏结局。数据收集自国际EECP患者注册研究（IEPR）中接受EECP疗程前后以及治疗完成后1年的患者。
在1532例接受研究的IEPR患者中，43%在基线时患有糖尿病。糖尿病患者平均每周经历11次心绞痛发作。大多数患者先前已接受经皮冠状动脉介入治疗或冠状动脉旁路移植术进行血运重建（86%），并且大多数被认为不适合进行任何一种额外的手术（87%）。79%的患者按规定完成了治疗（平均32小时）。EECP治疗后立即有69%的糖尿病患者心绞痛减轻≥1个加拿大心血管学会心绞痛分级。1年后，72%的糖尿病患者报告心绞痛减轻得以维持。生活质量得到显著改善。尽管本研究中的糖尿病组具有高风险特征，但1年死亡率与冠状动脉介入注册研究人群相似。
本研究表明，对于某些糖尿病患者，EECP可以是一种安全、有效且耐受性良好的缓解心绞痛的治疗选择。
