Spinal cord stimulation for refractory chronic angina pectoris: 100 patients treated in our 12-year experience

BACKGROUND: The aim of this study was to evaluate the quality of life (QoL) benefit of patients with chronic refractory angina treated with spinal cord stimulation (SCS) in our experience. METHODS: Between February 1998 and August 2010, 100 patients with chronic refractory angina who could not benefit from myocardial revascularization underwent SCS at the San Raffaele Scientific Institute of Milan (Italy). All patients were prospectively followed up at our outpatient clinic. The Spitzer index was used to evaluate QoL of patients before the procedure and at follow-up. RESULTS: Mean age was 66 ± 8 years (range 46-79). Ninety-four patients (94%) were in CCS class III-IV (mean CCS class 3.5 ± 0.1) and 62 patients (62%) were in NYHA class III-IV (mean NYHA class 2.6 ± 0.1). The preoperative Spitzer index was 4.4 ± 1.4. Mean angina episodes per week were 12.6 ± 9.3 and mean consumption of sublingual nitrates was 11.0 ± 9.4. At follow-up, overall mortality was 11% (n = 11), and cardiovascular death was 3%. A reduction in angina episodes per week >50% was observed in 88% of patients (from 12.6 ± 9.3 to 2.7 ± 1.13; p<0.0001). Mean consumption of sublingual nitrates decreased from 11.0 ± 9.4 to 2.3 ± 0.1 (p<0.0001). The Spitzer index significantly improved (from 4.4 ± 0.1 to 2.3 ± 0.1; p<0.0001). NYHA class and CCS class decreased from 2.6 ± 0.1 to 2.0 ± 0.1 and from 3.5 ± 0.1 to 1.7 ± 0.1, respectively (both p<0.0001). CONCLUSIONS: SCS is an effective and safe therapeutic option for patients with chronic refractory angina and it is associated with improved functional status and QoL at follow-up