Experience with enhanced external counterpulsation (EECP®) in coronary artery disease

The ischemia resulting from arterial narrowing in coronary artery disease (CAD) typically leads to symptoms of angina pectoris in affected patients. The frequent chest pain, shortness of breath and fatigue associated with angina significantly restrict patients' daily functioning, limiting their ability to walk and greatly reducing overall quality of life. While sublingual nitroglycerin may help to control angina symptoms to some extent, many CAD patients ultimately require invasive revascularization through the use of coronary angioplasty or bypass graft surgery. For patients with moderate to severe symptoms of chronic angina who are not candidates for such an invasive intervention, an alternative non-invasive procedure, enhanced external counterpulsation (EECP®), has proven very effective. In the MUST-EECP trial, a multicenter, placebo-controlled study, CAD patients who received EECP® therapy showed statistically significant post-treatment reductions in angina symptoms, extended symptom-free treadmill times, and improved duration of stress testing before developing EKG changes diagnostic for ischemia. Treated patients also exhibited statistically significant improvement in quality-of-life measures following a 7-week course of EECP® counterpulsation, and this favorable effect was maintained and frequently increased over the subsequent 12 months. EECP® therapy should be considered an important treatment modality for patients with angina, and has also recently received approval from the U.S. Food and Drug Administration (FDA) for use in treating patients with congestive heart failure.

Duke Scholars

Author Lawrence Edward Crawford Medicine, Cardiology