Abdelwahab Amr A, Elsaied Ayman M
Department of Cardiothoracic Surgery, Tanta University Hospital and Consultant Cardiac Surgeon at Al-Hayat Cardiology Centre, Tanta, Egypt.
Department of Cardiology and Vascular Medicine, Tanta University Hospital and Medical Manager of Al-Hayat Cardiology Centre, Tanta, Egypt.
Egypt Heart J. 2018 Jun;70(2):119-123. doi: 10.1016/j.ehj.2018.01.002. Epub 2018 Feb 1.
Angina symptom in patients with ischemic cardiomyopathy (ICM) after coronary artery bypass grafting (CABG) surgery is a major challenging problem in practice. The choice among different treatment modalities available can be judged by different parameters especially measuring the risk/cost ratio to achieve the benefit. Enhanced external counter pulsation (EECP) is one of safest noninvasive modality for treatment of angina as well as it has an anti-failure effect.
42 patients with ICM after CABG were suffering from stable angina and were treated at Al-Hayat Cardiology Centre in Tanta City (ACC). 20 patients of them (group A) received 35 sessions of EECP plus their anti-ischemic and anti-failure treatment, while the other 22 patients (group B) received only medical treatment and were followed up for 3 months regarding their angina class, functional class, frequency of angina attack, frequency of sublingual nitrate and rate of rehospitalization when needed during follow up period.
Despite both groups had nearly similar severity of symptoms regarding the CCS class and NYHA class, yet patients in group A experienced significant improvement in comparison to patients in group B (p-value = .005, p-value = .002 respectively), and this was reflected on frequency of angina and need for sublingual nitrates per week which showed significant decrease in group A (p-value = .001).
As a non-invasive treatment modality EECP is very effective in improving the symptoms of angina and heart failure when combined with medical treatment in patients with ICM after CABG.
冠状动脉旁路移植术（CABG）后缺血性心肌病（ICM）患者的心绞痛症状是临床实践中的一个重大难题。在可用的不同治疗方式中进行选择，可以通过不同参数来判断，尤其是衡量风险/成本比以实现获益。增强型体外反搏（EECP）是治疗心绞痛最安全的非侵入性方式之一，并且具有抗心力衰竭作用。
42例CABG术后的ICM患者患有稳定型心绞痛，在坦塔市的海亚特心脏病中心（ACC）接受治疗。其中20例患者（A组）接受35次EECP治疗并联合抗缺血和抗心力衰竭治疗，而另外22例患者（B组）仅接受药物治疗，并在随访3个月期间观察其心绞痛分级、心功能分级、心绞痛发作频率、舌下含服硝酸酯类药物的频率以及需要再次住院的比率。
尽管两组在加拿大心血管学会（CCS）分级和纽约心脏协会（NYHA）分级方面症状严重程度相近，但A组患者与B组患者相比有显著改善（p值分别为0.005和0.002），这体现在心绞痛频率和每周舌下含服硝酸酯类药物的需求上，A组显著降低（p值 = 0.001）。
作为一种非侵入性治疗方式，EECP与药物治疗联合应用时，对改善CABG术后ICM患者的心绞痛和心力衰竭症状非常有效。
