Comparing Treatments for Angina: Spinal Cord Stimulation vs. Laser Revascularization
Author Information
Author(s): Sadia N Khan, Duncan C McNab, Linda D Sharples, Carol J Freeman, Ian Hardy, David L Stone, Peter M Schofield
Primary Institution: Papworth Hospital, Cambridge, UK
Hypothesis
Does spinal cord stimulation (SCS) or percutaneous myocardial laser revascularisation (PMR) lead to better myocardial perfusion in patients with refractory angina?
Conclusion
There was no significant difference in myocardial perfusion one year post treatment with SCS or PMR.
Supporting Evidence
- 68 subjects were randomised, with 34 receiving SCS and 34 receiving PMR.
- At 12 months, there was no significant difference in summed rest score or summed stress score between the two groups.
- More SCS patients showed a 2-class improvement in CCS class compared to PMR patients, but this was close to significance.
Takeaway
Doctors wanted to see if two treatments for chest pain worked better than the other, but they found out that neither made a big difference in heart blood flow after a year.
Methodology
This was a randomised controlled trial comparing SCS and PMR in patients with refractory angina, with myocardial perfusion assessed at baseline and 12 months post intervention.
Potential Biases
The subjective nature of angina symptoms may introduce bias in interpreting treatment efficacy.
Limitations
The study was relatively small and not powered for the secondary outcome measure of myocardial perfusion.
Participant Demographics
Patients had Canadian Cardiovascular Society class 3/4 angina and reversible perfusion defects.
Statistical Information
Confidence Interval
95% CI: -2.1, 2.1 for SRS; 95% CI: -6.8, 2.0 for SSS
Statistical Significance
p = 1.0 for SRS, p = 0.29 for SSS
Digital Object Identifier (DOI)
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