Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, California 95211, USA.
Pharmacotherapy. 2010 Jul;30(7):639-45. doi: 10.1592/phco.30.7.639.
To evaluate the true magnitude of benefit from enhanced external counterpulsation (EECP) by determining the effect of EECP on Canadian Cardiovascular Society (CCS) angina class in patients with chronic stable angina.
Meta-analysis of 13 prospective studies that evaluated patients with stable angina and reported adequate data on CCS angina class.
A total of 949 adult patients with stable angina who underwent EECP treatment.
A systematic literature search of studies published between 1950 and February 2009 was performed. Studies were included for meta-analysis if they were reported in the English language, included human subjects, had a prospective study design, and reported adequate data on CCS angina class. The EECP treatment consisted of 35 sessions-1 hour/day, 5 days/week, for 7 weeks. Improvement in angina class was reported as the weighted proportion of patients improving by at least one CCS class from before to after EECP treatment. Heterogeneity was assessed by performing subgroup analyses and using the Cochran Q statistic. Publication bias was assessed by inspection of funnel plots and the Egger bias statistic. Among the 13 studies incorporating 949 patients, angina class was reduced by at least one CCS score in 86% of the patients (95% confidence interval 82-90%, Q statistic p=0.008]. Inspection of funnel plots showed some asymmetry, but the Egger bias statistic showed no publication bias (p=0.97).
The results of our meta-analysis call for further long-term studies to determine the place of EECP therapy in the management of chronic stable angina. Currently, EECP therapy should be considered for patients with stable angina who are refractory to or not suitable for invasive therapy and/or medical management.
通过确定增强型体外反搏（EECP）对慢性稳定型心绞痛患者加拿大心血管学会（CCS）心绞痛分级的影响，评估 EECP 带来的实际获益幅度。
对 13 项评估稳定型心绞痛患者并报告了 CCS 心绞痛分级充分数据的前瞻性研究进行荟萃分析。
共纳入 949 例接受 EECP 治疗的稳定型心绞痛成年患者。
对 1950 年至 2009 年 2 月发表的研究进行了系统的文献检索。如果研究以英文报告、包含人体受试者、采用前瞻性研究设计、并报告了 CCS 心绞痛分级的充分数据，则纳入荟萃分析。EECP 治疗包括 35 个疗程-每天 1 小时，每周 5 天，持续 7 周。心绞痛分级的改善报告为 EECP 治疗前后至少提高一个 CCS 分级的患者的加权比例。通过进行亚组分析和使用 Cochran Q 统计量评估异质性。纳入的 13 项研究共纳入 949 例患者，其中至少有 86%的患者心绞痛分级降低至少一个 CCS 评分（95%置信区间 82-90%，Q 统计量 p=0.008]）。对漏斗图的检查显示存在一些不对称，但 Egger 偏倚统计量显示无发表偏倚（p=0.97）。
我们的荟萃分析结果呼吁进一步开展长期研究，以确定 EECP 治疗在慢性稳定型心绞痛管理中的地位。目前，对于对侵入性治疗和/或药物治疗不耐受或不适合的稳定型心绞痛患者，应考虑 EECP 治疗。
