Ziad Sanaz, Malik Jamil, Isiguzo Obinna, Xu Lang, Chen Leqi, Cox Annette, Shah Sachin A
Department of Pharmacy Practice, Thomas J Long School of Pharmacy, University of The Pacific Stockton, CA, USA.
Cardiologist, Methodist Texsan Hospital San Antonio, TX, USA.
Am J Cardiovasc Dis. 2020 Dec 15;10(5):593-601. eCollection 2020.
Enhanced external counterpulsation (EECP) and ranolazine are approved treatments for patients with chronic stable angina by the United States Food and Drug Administration (FDA). Whether EECP offers clinical benefits regardless of underlying ranolazine therapy needs further investigation.
This was a retrospective evaluation of patients referred to a specialized EECP center. Patients having data on 6-Minute Walk Distance (6MWD) or Duke Activity Status Index (DASI) were categorized into two groups (EECP with ranolazine or EECP only). The primary endpoints were change in 6MWD and DASI before and after a full course of EECP within each of the two groups. Inter-group differences were also assessed. The Wilcoxon test was utilized to compare the change from baseline within each group and the Mann-Whitney U test to compare difference between groups.
A total of 2836 patient records (age 66.9 ± 10 years) were identified (1193 in EECP and ranolazine group and 1643 in EECP only group). EECP added to baseline ranolazine resulted in a statistically significant improvement in 6MWD and DASI (+126 feet (IQR: 230 feet), and +13.35 (IQR: 17.11), respectively, P<0.001 for both). Similarly, the EECP only group showed a statistically significant improvement in 6MWD and DASI (+140 feet (IQR: 225 feet) and +13.49 (IQR: 18.02), respectively, P<0.001 for both). There was no statistically significant difference between the two groups when comparing the change from baseline in 6MWD and DASI score (P=0.256 and P=0.056 respectively).
EECP improves markers of functional capacity regardless of baseline ranolazine therapy. EECP's unique safety profile advocates for its early consideration in the treatment algorithm.
增强型体外反搏（EECP）和雷诺嗪已被美国食品药品监督管理局（FDA）批准用于慢性稳定型心绞痛患者的治疗。EECP无论在基础雷诺嗪治疗的情况下是否都能提供临床益处，这一点尚需进一步研究。
这是一项对转诊至专业EECP中心的患者进行的回顾性评估。有6分钟步行距离（6MWD）或杜克活动状态指数（DASI）数据的患者被分为两组（联合雷诺嗪的EECP组或单纯EECP组）。主要终点是两组中每组在EECP全疗程前后6MWD和DASI的变化。还评估了组间差异。采用Wilcoxon检验比较每组内与基线的变化，采用Mann-Whitney U检验比较组间差异。
共识别出2836份患者记录（年龄66.9±10岁）（联合雷诺嗪的EECP组1193例，单纯EECP组1643例）。在基线雷诺嗪治疗基础上加用EECP导致6MWD和DASI有统计学意义的改善（分别增加126英尺（四分位间距：230英尺）和13.35（四分位间距：17.11），两者P<0.001）。同样，单纯EECP组在6MWD和DASI方面也有统计学意义的改善（分别增加140英尺（四分位间距：225英尺）和13.49（四分位间距：18.02），两者P<0.001）。比较6MWD和DASI评分与基线的变化时，两组之间无统计学显著差异（分别为P=0.256和P=0.056）。
无论基线雷诺嗪治疗情况如何，EECP均可改善功能能力指标。EECP独特的安全性表明应在治疗方案中尽早考虑使用它。
