I've been searching around and I found this article that was sceptical of EECP. It was published in January, so the author may have changed his opinion. Perhaps I will write to him and ask.
Here are some other links;
heartcenter.com
wwwcardio.his.ucsf.edu
Regards,
Mark
clinical-cardiology.org
Clin. Cardiol. 20, 1 (1997)
Editor's Note
Advertising of Therapies for Cardiovascular Patients
Thomas E. Hearon, III, M.D., FACC, colleague in cardiology in Columbia, South Carolina, wrote to me about an advertisement that he saw in his local newspaper regarding the benefits of enhanced external counterpulsation (EECP). The advertisement indicated that "angioplasty and bypass surgery are not guaranteed. EECP is!" The ad went on to say that this therapy was "FDA allowed" (not FDA approved). It also went on to say that the therapy "can reduce or eliminate chest pain," it may "decrease your need for medication," and "improve your ability to participate in daily activities," "carries little or no risk," and is "administered in out-patient sessions." The ad also indicated that "94% find long-term relief from angina."
I have a distaste for advertising such as this--in a previous editorial I stated my views on chelation therapy.1 The ad in question referenced an article published in the American Journal of Cardiology in 1995.2 I read this article, which was written by Peter Cohn's group. The lead author is Lawson.
Let me say at the outset that I respect this group. They are first-rate clinical scientists who are trying to evaluate a treatment strategy that seemed to make some clinical sense. In fact, EECP is postulated to work by facilitating the development or opening of coronary collaterals as has been reported with the use of intraortic balloon counterpulsation according to Lawson and colleagues. They reason that EECP may improve inequalities of regional perfusion, resulting in both subjective and objective improvement in patients with ischemic heart disease.
I would like to review for the reader the important points that I took from Lawson's article.
First, patients reported by Lawson et al. received 36 hours of EECP. I assume this treatment required hospitalization. The ad indicates that the treatment will be administered in out-patient settings.
In the study, eight patients received supplemental EECP during the follow-up period. The duration of that therapy is not indicated in the manuscript.
Before entry into the trial, all patients were experiencing angina, and were limited despite what appears to be aggressive antianginal therapy. Eight of the patients had had a previous revascularization procedure, and all patients had evidence of ischemia as determined by reversible perfusion abnormalities on stress thallium imaging.
According to the article, angina symptoms improved in all patients early after EECP. Strikingly, thallium imaging revealed improved thallium perfusion in 14 of 18 patients (78%), and 4 showed no objective benefit. In the 14 EECP responders, one had a subsequent myocardial infarction and one underwent surgical revascularization in the 3-year follow-up. The remaining patients continue to be free of limiting angina. Of the 14 EECP responders, 10 underwent repeat stress thallium at the three year mark; 8 of these continued to show improved thallium perfusion and 2 did not.
The authors indicate that future angiographic studies are planned to evaluate collateral function in these patients, but as far as I can tell that study has not been published.
I have the following comments based on the advertisement and the scientific publication. First of all, 94% of patients did not find long-term relief from angina. Second, the scientific paper indicated 36 hours of treatment and the advertisement indicates that this can been administered on an outpatient basis. I have no concern about the advertisement indicating that treatment can reduce or eliminate chest pain, may decrease the need for medication, may improve the ability to participate in daily activities, and carries little or no risk.
I do have a concern that the lay public and some physicians may assume that this treatment is some kind of a cure-all and may forget about other issues such as pharmacologic therapy and risk-factor modification.
Finally, it would be nice if the 18 patients reported in this observational study had a control group.
C. Richard Conti, M.D.
Editor-in-Chief
References
1. Conti CR: Chelation therapy for atherosclerosis: One man's view. Clin Cardiol 1995;18:545
2. Lawson WE, Hui John CK, Zheng ZS, Oster Z, Katz JP, Diggs P, Burger L, Cohn CD, Soroff HS, Cohn PF: Three-year sustained benefit from enhanced external counterpulsation in chronic angina pectoris. J Am Coll Cardiol 1995;75:840 - 842. |
