ArticleThe American journal of cardiology2024
Enhanced External Counterpulsation for the Treatment of Angina With Nonobstructive Coronary Artery Disease.
Article in The American journal of cardiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.
- A systematic review of enrolment criteria and treatment efficacy for microvascular angina.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2025Pooled it
- Enhanced External Counterpulsation Versus Standard Medical Therapy for Chronic Refractory Angina: A Systematic Review and Meta-Analysis.Biomedicines · 2026Review
- Clinical efficacy comparison between extracorporeal shock wave therapy and enhanced external counterpulsation for coronary heart disease.International journal of cardiology. Cardiovascular risk and prevention · 2026Article
- Effects of EECP combined with individualized cardiac exercise rehabilitation on lipoprotein(a) levels in patients with coronary heart disease.Open medicine (Warsaw, Poland) · 2026Article
- Refractory angina: mechanisms and stratified treatment in obstructive and non-obstructive chronic myocardial ischaemic syndromes.European heart journal · 2025Review
- Effects of Cardiac Rehabilitation Combined with Enhanced External Counterpulsation on Heart Rate Variability and Autonomic Nervous Function in Chronic Heart Failure.Cardiovascular toxicology · 2025Article
- Integrative cardiovascular disease therapy: Linoleic acid restriction, enhanced external counterpulsation, and emerging nanotherapies.World journal of cardiology · 2025Review
- Current Evidence-Based Treatment of Angina With Nonobstructive Coronary Arteries (ANOCA).Journal of the Society for Cardiovascular Angiography & Interventions · 2025Review
- Treatment Modalities for Angina with Non-Obstructive Coronary Arteries (ANOCA): A Systematic Review and Meta-Analysis.Journal of clinical medicine · 2025Review
- Ischemia with no obstructed coronary arteries and microvascular testing procedures: a review of utility, pharmacotherapy, and current challenges.Frontiers in cardiovascular medicine · 2025Review
- Evaluation of enhanced external counterpulsation with different modes on acute hemodynamic effects.Frontiers in physiology · 2025Article
- Utilizing Invasive Coronary Functional Testing in a Coronary Microvascular and Vasomotor Dysfunction Program: Methods and Considerations.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2024Article
- Developing a Women's Heart Center With a Specialization in Coronary Microvascular and Vasomotor Dysfunction: If You Build It, They Will Come.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2024Review
- Enhanced External Counterpulsation Improves Long COVID-Associated Symptoms.The American journal of cardiology · 2024Article
Corrections and comments
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Authors and funding
11 authors at 3 institutions in 1 country.
Funding
Abstract
Angina and nonobstructive coronary artery disease (ANOCA) is associated with poor outcomes and limited treatment options. Enhanced external counterpulsation (EECP) is a noninvasive treatment that involves applying external inflatable cuffs to the lower extremities to increase blood flow during diastole, followed by deflation during systole. Although EECP is approved for treatment in patients with refractory angina due to obstructive coronary artery disease, its effectiveness in treating patients with ANOCA with refractory angina is limited to small studies. We assessed the efficacy of EECP treatment in patients with ANOCA (defined as ≤50% stenosis in any major epicardial vessels) with refractory anginaby measuring changes in Canadian Cardiovascular Society (CCS) angina class, 6-minute walk test, Duke Activity Status Index (DASI), Seattle Angina Questionnaire 7 (SAQ7), and weekly anginal episodes pre-EECP and post-EECP treatment. A total of 101 patients with ANOCA with CCS class III/IV angina completed a full course of EECP treatment at 2 large EECP centers. In 101 patients with ANOCA the mean age (SD) of 60.6 (11.3) years and 62.4% of the cohort were women. We found significant improvements post-EECP treatment in CCS angina class (mean (SD) 3.4 (0.5) to 2.4 (2.9), p <0.001), 6-minute walk test (median 1200 (IQR 972 to 1411) to 1358 (1170 to 1600), p <0.001), DASI (mean (SD) 15.2 (11.6) to 31.5 (16.3), p <0.001), SAQ7 (mean (DS) 36.2 (24.7) to 31.5 (16.3), p <0.001), and weekly anginal episodes (mean (SD) 5.3 (3.5) to 2.4 (2.9), p <0.001). After EECP treatment, 71 patients (70.3%) had an improvement of ≥1 CCS angina class, including 33 (32.7%) patients improving by ≥2 CCS classes. In conclusion, in patients with ANOCA, EECP therapy reduces CCS angina class and improves exercise tolerance and capacity; and should be considered a part of optimal medical therapy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.