Spinal cord stimulation provided equivalent symptom relief to CABG and lower mortality (1.9% vs 13.7%, P=0.02) in severe angina patients with increased surgical risk.
RCT (n=104)
randomized
Does spinal cord stimulation improve symptoms and outcomes compared to coronary artery bypass grafting in patients with severe angina pectoris and increased surgical risk?
Spinal cord stimulation may be a viable therapeutic alternative to CABG for symptom relief in severe angina patients with increased surgical risk, potentially offering lower short-term mortality and morbidity.
Absolute Event Rate: 1.9% vs 13.7%
p-value: p=0.02
BACKGROUND: Spinal cord stimulation (SCS) has been shown to have antianginal and anti-ischemic effects in severe angina pectoris. The present study was performed to investigate whether SCS can be used as an alternative to coronary artery bypass grafting (CABG) in selected patient groups, ie, patients with no proven prognostic benefit from CABG and with an increased surgical risk. METHODS AND RESULTS: One hundred four patients were randomized (SCS, 53; CABG, 51). The patients were assessed with respect to symptoms, exercise capacity, ischemic ECG changes during exercise, rate-pressure product, mortality, and cardiovascular morbidity before and 6 months after the operation. Both groups had adequate symptom relief (P<.0001), and there was no difference between SCS and CABG. The CABG group had an increase in exercise capacity (P=.02), less ST-segment depression on maximum (P=.005) and comparable (P=.0009) workloads, and an increase in the rate-pressure product both at maximum (P=.0003) and comparable (P=.03) workloads compared with the SCS group. Eight deaths occurred during the follow-up period, 7 in the CABG group and 1 in the SCS group. On an intention-to-treat basis, the mortality rate was lower in the SCS group (P=.02). Cerebrovascular morbidity was also lower in the SCS group (P=.03). CONCLUSIONS: CABG and SCS appear to be equivalent methods in terms of symptom relief in this group of patients. Effects on ischemia, morbidity, and mortality should be considered in the choice of treatment method. Taking all factors into account, it seems reasonable to conclude that SCS may be a therapeutic alternative for patients with an increased risk of surgical complications.
Mannheimer et al. (1998) conducted an RCT in severe angina pectoris (n=104). Spinal cord stimulation vs. Coronary artery bypass grafting (CABG) was evaluated on Mortality (p=0.02). Spinal cord stimulation provided equivalent symptom relief to CABG and lower mortality (1.9% vs 13.7%, P=0.02) in severe angina patients with increased surgical risk.