EECP significantly improved AT-VO2Kg, Max-VO2Kg, AT-O2puls, AT-Mets, and Max-Mets compared with the non-EECP group (p 0.05). Of the patients who had repeat ECP, 59 % also had class 0 to II angina compared with 82 % of those who did not undergo repeat ECP (p 0.05) before treatment. Although patients who underwent repeat ECP did benefit from the 2 courses of therapy, the symptomatic improvement was not sustained. Of those who underwent repeat ECP, 70 % had a decrease of 1 or more angina classes at the end of repeat ECP with similar decreases in nitroglycerin use. Within 2 years of the initial course of ECP, the rate of repeat ECP was 18 %, which occurred at a mean interval of 378 days after initial ECP.
#Class iii angina full
Michaels et al (2005) reviewed registry data to assess the frequency, efficacy, predictors, and long-term success of repeat ECP therapy in relieving angina in patients who had chronic angina and had undergone a full course of ECP. There is no reliable evidence that clinical outcomes of ECP are improved with prolonged courses of treatment.
#Class iii angina trial
The pivotal randomized controlled trial of ECP, the MUST-ECP trial, employed a 35-hour protocol (Arora et al, 1999). A full course of ECP typically involves 5 hours of treatment per week, delivered in 1- to 2-hour sessions for 7 weeks, for a total of 35 hours of treatment (Arora et al, 1999 CMS, 2006). Long-term benefit is expected to result as coronary collateral flow to ischemic regions of the myocardium is increased.
In the short-term, this method of therapy is thought to deliver more oxygen to the ischemic myocardium by increasing coronary blood flow during diastole, while at the same time reducing the demand for oxygen by diminishing the work requirements of the heart. The cuffs are deflated simultaneously just prior to systole, which produces a rapid drop in vascular impedance, a decrease in ventricular work-load and an increase in cardiac output. This action results in an increase in diastolic pressure, generation of retrograde arterial blood flow and an increase in venous return. During diastole the 3 sets of air cuffs are inflated sequentially (distal to proximal) compressing the vascular beds within the muscles of the calves, lower thighs and upper thighs. The cuffs are larger versions of the familiar blood pressure cuff.
#Class iii angina series
A series of 3 compressive air cuffs that inflate and deflate in synchronization with the patient's cardiac cycle via microprocessor-interpreted ECG signals are wrapped around each leg one at calf level, another slightly above the knee and the third on the thigh. Three or more months has elapsed from the prior ECP treatment.Īetna considers the use of ECP for all other conditions (e.g., abnormal glucose tolerance, aortic insufficiency, arrhythmia, atherosclerosis obliterans of the lower extremity, chronic cerebrovascular occlusive disease, erectile dysfunction, fatigue/malaise, heart failure, hepato-renal syndrome, hypertension, improvement of exercise endurance in individuals with chronic obstructive pulmonary disease peripheral vascular disease or phlebitis, restless leg syndrome, retinal artery occlusion, rotational vertebro-basilar insufficiency, stroke, sudden deafness, tinnitus, and unstable angina) experimental and investigational because its effectiveness for indications other than the one listed above has not been established.Īetna considers hydraulic versions of these devices not medically necessary.Įxternal counterpulsation (ECP) is a non-invasive, outpatient treatment for coronary artery disease with angina refractory to medical and/or surgical therapy.
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