Angina Relief in Diabetic Patients Who Are Not Candidates for Transcatheter Intervention

Background: Percutaneous coronary Intervention in the diabetic patient is problematic. Enhanced external counterpulsation (EECP) is a noninvasive analogue of the intra-aortic balloon pump designed to increase myocardial perfusion pressure and decrease cardiac workload. EECP has been demonstrated to be safe and effectwe in treating angina; however, the effectiveness of EECP for the treatment of angina in diabetic patients who are not considered candidates for transcatheter lntewention is unknown. Methods: We analyzed demographic and clinical outcome data from 616 diabetic patients (from 32 sites) diagnosed with Canadian Cardiovascular Society (CCS) class Ill or IV angina who were not revascularization candidates by referring physician’s assessment. EECP was given l-2 hours daily with 79% of patients completing a course of treatment (mean, 37 hours). Patients were followed for six months. Results: The mean age was 66 years. and 36% were female. Coronary artery disease was of long duration (mean, 11 years), frequently multwessel (81%), and most patients had prior percutaneous coronary intervention (74%) or coronary artery bypass surgery (72%). Congestive heart failure (44%), and previous myocardial infarction (73%) were reported often (mean left ventricular ejection fraction, 45%). Patients were highly symptomatic, reporting 11.5 episodes of angina/week, requirmg 10.2 sublingual nitroglycerin1 week. Medical management was considered optimal. Upon completion of treatment, 88% of patients reported a decrease of >= 1 CCS angina class wth 63% reporting class II, I, or no angina. There was a decrease of 8.7 angina1 episodes/week with a concomitant decrease of 13.2 nitroglycerin/week. At xx-month follow-up, angina reduction was maintained in 74% of patients with 74% repomng class II, I, of no angina. Conclusion: Despite steady improvement in transcatheter interventional techniques and outcomes, there is a growing population of patients who have exhausted the revascularization armamentarium. Novel treatments such as EECP can offer angina reduction with maintenance of benefit for select diabetic patients with advanced coronary artery dis