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Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomised controlled trials.

Taylor RS, De Vries J, Buchser E, Dejongste MJ - BMC Cardiovasc Disord (2009)

Bottom Line: Given the variety in outcomes reported, some outcome results were pooled as standardised mean differences (SMD) and reported in standard deviation units.The outcomes of SCS were found to be similar when directly compared to coronary artery bypass grafting (CABG) and percutaneous myocardial laser revascularisation (PMR).SCS appears to be an effective and safe treatment option in the management of refractory angina patients and of similar efficacy and safety to PMR, a potential alternative treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Services Research, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, UK. rod.taylor@pms.ac.uk.

ABSTRACT

Background: The aim of this paper was undertake a systematic review and meta-analysis of the use of spinal cord stimulation (SCS) in the management of refractory angina.

Methods: We searched a number of electronic databases including Medline, Embase and Cochrane Library up to February 2008 to identify randomised controlled trials (RCTs) reporting exercise capacity, ischemic burden, functional class, quality of life, usage of anti-anginal medication, costs and adverse events including mortality. Results were reported both descriptively for each study and using random effects meta-analysis. Given the variety in outcomes reported, some outcome results were pooled as standardised mean differences (SMD) and reported in standard deviation units.

Results: Seven RCTs were identified in a total of 270 refractory angina patients. The outcomes of SCS were found to be similar when directly compared to coronary artery bypass grafting (CABG) and percutaneous myocardial laser revascularisation (PMR). Compared to a 'no stimulation' control, there was some evidence of improvement in all outcomes following SCS implantation with significant gains observed in pooled exercise capacity (SMD: 0.76, 0.07 to 1.46, p = 0.03) and health-related quality of life (SMD: 0.83, 95% CI: 0.32 to 1.34, p = 0.001). Trials were small and were judged to range considerably in their quality. The healthcare costs of SCS appeared to be lower than CABG at 2-years follow up.

Conclusion: SCS appears to be an effective and safe treatment option in the management of refractory angina patients and of similar efficacy and safety to PMR, a potential alternative treatment. Further high quality RCT and cost effectiveness evidence is needed before SCS can be accepted as a routine treatment for refractory angina.

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Exercise capacity – between-group difference.
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Figure 2: Exercise capacity – between-group difference.

Mentions: Six studies assessed exercise capacity, reporting outcomes using a number of metrics (e.g. exercise duration, maximum oxygen uptake and peak workload) [19,23,24,27-29]. Of the four studies that reported the within group difference in outcome between baseline and follow up with SCS, three found a statistically significant improvement in exercise capacity (Table 3). Although in the ESBY study no significant change in maximum work capacity was observed 6-months post-implant, SCS was inactivated during the exercise test. As shown in Figure 2, in the pooled analysis there was a superior exercise capacity with active SCS compared to no SCS or SCS OFF (SMD: 0.76, 0.07 to 1.46, p = 0.03, heterogeneity test: χ2 = 7.4, p = 0.06, I2 = 60%). Compared to both CABG and PMR no significant difference was seen in exercise capacity scores at follow up. However, when adjusted for baseline values, the ESBY trial authors did report a small difference in exercise capacity at follow up in favour of CABG (p = 0.03).


Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomised controlled trials.

Taylor RS, De Vries J, Buchser E, Dejongste MJ - BMC Cardiovasc Disord (2009)

Exercise capacity – between-group difference.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2667170&req=5

Figure 2: Exercise capacity – between-group difference.
Mentions: Six studies assessed exercise capacity, reporting outcomes using a number of metrics (e.g. exercise duration, maximum oxygen uptake and peak workload) [19,23,24,27-29]. Of the four studies that reported the within group difference in outcome between baseline and follow up with SCS, three found a statistically significant improvement in exercise capacity (Table 3). Although in the ESBY study no significant change in maximum work capacity was observed 6-months post-implant, SCS was inactivated during the exercise test. As shown in Figure 2, in the pooled analysis there was a superior exercise capacity with active SCS compared to no SCS or SCS OFF (SMD: 0.76, 0.07 to 1.46, p = 0.03, heterogeneity test: χ2 = 7.4, p = 0.06, I2 = 60%). Compared to both CABG and PMR no significant difference was seen in exercise capacity scores at follow up. However, when adjusted for baseline values, the ESBY trial authors did report a small difference in exercise capacity at follow up in favour of CABG (p = 0.03).

Bottom Line: Given the variety in outcomes reported, some outcome results were pooled as standardised mean differences (SMD) and reported in standard deviation units.The outcomes of SCS were found to be similar when directly compared to coronary artery bypass grafting (CABG) and percutaneous myocardial laser revascularisation (PMR).SCS appears to be an effective and safe treatment option in the management of refractory angina patients and of similar efficacy and safety to PMR, a potential alternative treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Services Research, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, UK. rod.taylor@pms.ac.uk.

ABSTRACT

Background: The aim of this paper was undertake a systematic review and meta-analysis of the use of spinal cord stimulation (SCS) in the management of refractory angina.

Methods: We searched a number of electronic databases including Medline, Embase and Cochrane Library up to February 2008 to identify randomised controlled trials (RCTs) reporting exercise capacity, ischemic burden, functional class, quality of life, usage of anti-anginal medication, costs and adverse events including mortality. Results were reported both descriptively for each study and using random effects meta-analysis. Given the variety in outcomes reported, some outcome results were pooled as standardised mean differences (SMD) and reported in standard deviation units.

Results: Seven RCTs were identified in a total of 270 refractory angina patients. The outcomes of SCS were found to be similar when directly compared to coronary artery bypass grafting (CABG) and percutaneous myocardial laser revascularisation (PMR). Compared to a 'no stimulation' control, there was some evidence of improvement in all outcomes following SCS implantation with significant gains observed in pooled exercise capacity (SMD: 0.76, 0.07 to 1.46, p = 0.03) and health-related quality of life (SMD: 0.83, 95% CI: 0.32 to 1.34, p = 0.001). Trials were small and were judged to range considerably in their quality. The healthcare costs of SCS appeared to be lower than CABG at 2-years follow up.

Conclusion: SCS appears to be an effective and safe treatment option in the management of refractory angina patients and of similar efficacy and safety to PMR, a potential alternative treatment. Further high quality RCT and cost effectiveness evidence is needed before SCS can be accepted as a routine treatment for refractory angina.

Show MeSH
Related in: MedlinePlus