增强型体外反搏对左主干病变合并心绞痛患者的疗效

Effectiveness of enhanced external counterpulsation in patients with left main disease and angina.

作者信息

Lawson William E, Hui John C K, Barsness Gregory W, Kennard Elizabeth D, Kelsey Sheryl F

机构信息

SUNY Stony Brook, Stony Brook, New York 11740, USA.

出版信息

Clin Cardiol. 2004 Aug;27(8):459-63. doi: 10.1002/clc.4960270808.

DOI:10.1002/clc.4960270808

PMID:15346843

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6654733/

Abstract

BACKGROUND

Enhanced external counterpulsation (EECP) is a noninvasive device that uses three pairs of sequentially inflated pneumatic cuffs applied to the lower extremities and synchronized with the heart beat to provide diastolic augmentation, increase coronary blood pressure and flow, venous return and cardiac output, and decrease afterload.

HYPOTHESIS

This study examines the safety and effectiveness of EECP therapy in patients with significant left main coronary artery disease (LMD).

METHODS

In all, 2,861 patients enrolled in the International EECP Patient Registry (IEPR) were divided into three groups, those without LMD (n = 2,377), those with LMD and prior CABG (n = 431), and those with unbypassed LMD (n = 53).

RESULTS

Patients with LMD, with or without prior CABG, were significantly more likely to have triple-vessel disease (98.1 and 88.7%, respectively) than patients without LMD (41.9%). Post-EECP, 74% without LMD, 75% with LMD with prior CABG, and 65% with unbypassed LMD improved their Canadian Cardiovascular Society (CCS) angina by at least one class (p = NS). There were no differences in the mean decrease in weekly angina episodes (7.1 vs. 8.0 vs. 7.6) and in the mean frequency of weekly nitroglycerin use (6.6 vs. 8.1 vs. 8.9). At 6-month follow-up, the CCS class improved further in all three groups, and there was a further reduction in mean weekly angina episodes (4.7 vs. 4.6 vs. 5.3) and nitroglycerin use (6.5 vs. 6.8 vs. 8.2). Kaplan-Meier life table analysis 8 months after starting EECP demonstrated a major cardiovascular event rate of 11.2% in patients without LMD, 15.6% in LMD with CABG, and 24.3% in LMD without prior CABG. Late mortality in unbypassed LMD was 13.2% (confidence interval [CI] 3.3-23.1) versus 4.8% (CI 2.7-7.1) in LMD with CABG, and 2.8% (CI 2.1-3.5) without LMD (p = 0.0039 by log-rank test).

CONCLUSION

Enhanced external counterpulsation is equally effective in relieving angina in patients with or without LMD. However, the significantly increased late mortality in patients with LMD without prior CABG suggests that early revascularization should be considered in these patients.

摘要

背景

增强型体外反搏（EECP）是一种非侵入性设备，它使用三对依次充气的气动袖带，施加于下肢，并与心跳同步，以提供舒张期增压，增加冠状动脉血压和血流量、静脉回流及心输出量，并降低后负荷。

假设

本研究探讨EECP治疗对患有严重左主干冠状动脉疾病（LMD）患者的安全性和有效性。

方法

共有2861名患者纳入国际EECP患者注册研究（IEPR），并被分为三组，即无LMD的患者（n = 2377）、有LMD且既往接受冠状动脉搭桥术（CABG）的患者（n = 431）以及未搭桥LMD的患者（n = 53）。

结果

有LMD的患者，无论是否既往接受过CABG，其三支血管病变的发生率（分别为98.1%和88.7%）均显著高于无LMD的患者（41.9%）。EECP治疗后，无LMD的患者中有74%、有LMD且既往接受CABG的患者中有75%、未搭桥LMD的患者中有65%的加拿大心血管学会（CCS）心绞痛分级至少改善了一级（p = 无显著性差异）。每周心绞痛发作次数的平均减少量（7.1 vs. 8.0 vs. 7.6）以及每周硝酸甘油使用频率的平均减少量（6.6 vs. 8.1 vs. 8.9）均无差异。在6个月随访时，所有三组患者的CCS分级均进一步改善，每周心绞痛发作次数的平均值（4.7 vs. 4.6 vs. 5.3）和硝酸甘油使用量（6.5 vs. 6.8 vs. 8.2）均进一步减少。EECP开始治疗8个月后的Kaplan-Meier生存表分析显示，无LMD患者的主要心血管事件发生率为11.2%，有LMD且接受CABG患者为15.6%，未搭桥LMD患者为24.3%。未搭桥LMD患者的晚期死亡率为13.2%（置信区间[CI] 3.3 - 23.1），有LMD且接受CABG患者为4.8%（CI 2.7 - 7.1），无LMD患者为2.8%（CI 2.1 - 3.5）（对数秩检验p = 0.0039）。