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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.

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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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Health related quality of life – between-group difference. Based on NHP part 1 score for ESBY 1993; SF-36 physical health scale at 2-years for SPiRiT, 2006; ADL score for DeJongste 1994, EQ-5D VAS score for Eddicks 2008; LASA score for Hauvast 1998.
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Figure 5: Health related quality of life – between-group difference. Based on NHP part 1 score for ESBY 1993; SF-36 physical health scale at 2-years for SPiRiT, 2006; ADL score for DeJongste 1994, EQ-5D VAS score for Eddicks 2008; LASA score for Hauvast 1998.

Mentions: Five studies assessed health-related quality of life using validated instruments that included both generic (e.g. Short-Form 36, Nottingham Health Profile & EuroQoL (or EQ-5D)) and disease specific measures (Seattle Angina Questionnaire & Quality of Life Questionnaire – Angina Pectoris) [21,23,24,27,29]. The four studies that reported outcome at baseline and follow up, each found a significant improvement in quality of life (both generic and disease specific) with SCS (Table 3). Based on aggregate scores, pooled quality of life was superior for SCS compared to no SCS or SCS OFF (SMD: 0.83, 95% CI: 0.32 to 1.34, p = 0.001; Test of heterogeneity: χ2 = 0.9, p = 0.65, I2 = 0%). There was no significant difference in quality of life with SCS compared to either CABG or PMR (see Figure 5).


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)

Health related quality of life – between-group difference. Based on NHP part 1 score for ESBY 1993; SF-36 physical health scale at 2-years for SPiRiT, 2006; ADL score for DeJongste 1994, EQ-5D VAS score for Eddicks 2008; LASA score for Hauvast 1998.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Health related quality of life – between-group difference. Based on NHP part 1 score for ESBY 1993; SF-36 physical health scale at 2-years for SPiRiT, 2006; ADL score for DeJongste 1994, EQ-5D VAS score for Eddicks 2008; LASA score for Hauvast 1998.
Mentions: Five studies assessed health-related quality of life using validated instruments that included both generic (e.g. Short-Form 36, Nottingham Health Profile & EuroQoL (or EQ-5D)) and disease specific measures (Seattle Angina Questionnaire & Quality of Life Questionnaire – Angina Pectoris) [21,23,24,27,29]. The four studies that reported outcome at baseline and follow up, each found a significant improvement in quality of life (both generic and disease specific) with SCS (Table 3). Based on aggregate scores, pooled quality of life was superior for SCS compared to no SCS or SCS OFF (SMD: 0.83, 95% CI: 0.32 to 1.34, p = 0.001; Test of heterogeneity: χ2 = 0.9, p = 0.65, I2 = 0%). There was no significant difference in quality of life with SCS compared to either CABG or PMR (see Figure 5).

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