Chronic stable angina spinal cord stimulation: Difference between revisions
Jump to navigation
Jump to search
(New page: __NOTOC__ {{Chronic stable angina}} '''Editors-In-Chief:''' C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; {{CZ}}; '''Associate Editors-In-Chief:''' [[J...) |
No edit summary |
||
| Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{Chronic stable angina}} | {{Chronic stable angina}} | ||
==Spinal | '''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; {{CZ}}; '''Associate Editor(s)-In-Chief:''' [[John Fani Srour, M.D.]]; [[WikiDoc Scholars#WikiDoc Scholars with Distinction|Jinhui Wu, M.D.]]; [[Lakshmi Gopalakrishnan, M.B.B.S.]] | ||
==Overview== | |||
Spinal cord stimulation (SCS) uses an implanted device with an electrode tip that extends into the dorsal epidural space, usually at the C7-T1 level. | |||
==Mechanism of Benefit== | |||
*Spinal cord stimulation uses an implantable device with a atimulating electrode placed in the epidural space, usually at the level of C7-T1 and provides [[analgesia]] secondary to '''neuromodulation'''. | |||
SCS | *SCS benefits secondary to: | ||
:*Decrease in the neurotransmission of painful stimuli, | |||
:*Increase in the release of [[Opiod|endogenous opiates]], | |||
:*Redistributes myocardial blood flow to ischemic areas. | |||
==Indication== | |||
In patients with chronic stable angina refractory to [[Chronic stable angina pharmacotherapy overview|medical therapy]], [[Chronic stable angina revascularization percutaneous coronary intervention(PCI)|PCI]], and/or [[Chronic stable angina revascularization coronary artery bypass grafting(CABG)|surgical therapy]] ''(more data are still needed and therefore, spinal cord stimulation should be only considered when other treatment options have failed)''. | |||
==Supportive trial data== | |||
Several observational studies have reported success rates of up to 80% in decreasing anginal frequency and severity. | |||
==ACC / AHA Guidelines- | *Efficacy of spinal cord stimulation as a treatment for chronic intractable angina, was studied for 6 weeks in 13 treated patients versus 12 control patients with [[chronic stable angina definition|chronic angina]]. At 6-week follow-up, in comparison to the control group, the treated group demonstrated significant increase in the exercise duration ''(P=0.03)'' and the time to angina ''(P=0.01)''; and a significant reduction in the incidence of anginal attacks and [[Chronic stable angina treatment nitrates|sublingual nitrate consumption]] ''(P=0.01)'' and in the incidence of ischemic episodes on [[Chronic stable angina ambulatory ST segment monitoring|48-hour electrocardiogram]] ''(P=0.04)''. The [[ST segment depression]] on the [[Chronic stable angina exercise electrocardiography|exercise electrocardiogram]] decreased at comparable workload ''(P=0.01)'' with a significant increase in the perceived quality of life ''(P=0.03)''. Thus, the study concluded that spinal cord stimulation is an effective alternative the management of chronic intractable angina pectoris, and that its effect was exerted through anti-ischemic action.<ref name="pmid9842028">Hautvast RW, DeJongste MJ, Staal MJ, van Gilst WH, Lie KI (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9842028 Spinal cord stimulation in chronic intractable angina pectoris: a randomized, controlled efficacy study.] ''Am Heart J'' 136 (6):1114-20. PMID: [http://pubmed.gov/9842028 9842028]</ref> | ||
==ACC/AHA Guidelines- Spinal Cord Stimulation (DO NOT EDIT)<ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).]''Circulation'' 99 (21):2829-48. PMID: [http://pubmed.gov/10351980 10351980]</ref><ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58. PMID: [http://pubmed.gov/12515758 12515758]</ref>== | |||
{{cquote| | {{cquote| | ||
===Class IIb=== | ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]=== | ||
'''1.''' [[Spinal cord stimulation]] ([[SCS]]). ''(Level of Evidence: B)''}} | '''1.''' [[Spinal cord stimulation]] ([[SCS]]). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}} | ||
== | ==Vote on and Suggest Revisions to the Current Guidelines== | ||
*[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]] | *[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]] | ||
==Sources== | ==Sources== | ||
*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. PMID: [http://pubmed.gov/10351980 10351980]</ref> | *The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref> | ||
*TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58. PMID: [http://pubmed.gov/12515758 12515758]</ref> | *TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref> | ||
*The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72. [http:// | *Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= |url=url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 [http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf]}} </ref> | ||
*The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category: | [[Category:Ischemic heart diseases]] | ||
[[Category: | [[Category:Disease]] | ||
[[Category: Cardiology]] | |||
[[Category: Emergency medicine]] | [[Category:Cardiology]] | ||
[[Category:Emergency medicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Up-To-Date cardiology]] | |||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Revision as of 02:22, 4 October 2011
|
Chronic stable angina Microchapters | ||
|
Classification | ||
|---|---|---|
| ||
| ||
|
Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
|
Diagnosis | ||
|
Alternative Therapies for Refractory Angina | ||
|
Discharge Care | ||
|
Guidelines for Asymptomatic Patients | ||
|
Case Studies | ||
|
Chronic stable angina spinal cord stimulation On the Web | ||
|
to Hospitals Treating Chronic stable angina spinal cord stimulation | ||
|
Risk calculators and risk factors for Chronic stable angina spinal cord stimulation | ||
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Phone:617-632-7753; Cafer Zorkun, M.D., Ph.D. [4]; Associate Editor(s)-In-Chief: John Fani Srour, M.D.; Jinhui Wu, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
Spinal cord stimulation (SCS) uses an implanted device with an electrode tip that extends into the dorsal epidural space, usually at the C7-T1 level.
Mechanism of Benefit
- Spinal cord stimulation uses an implantable device with a atimulating electrode placed in the epidural space, usually at the level of C7-T1 and provides analgesia secondary to neuromodulation.
- SCS benefits secondary to:
- Decrease in the neurotransmission of painful stimuli,
- Increase in the release of endogenous opiates,
- Redistributes myocardial blood flow to ischemic areas.
Indication
In patients with chronic stable angina refractory to medical therapy, PCI, and/or surgical therapy (more data are still needed and therefore, spinal cord stimulation should be only considered when other treatment options have failed).
Supportive trial data
Several observational studies have reported success rates of up to 80% in decreasing anginal frequency and severity.
- Efficacy of spinal cord stimulation as a treatment for chronic intractable angina, was studied for 6 weeks in 13 treated patients versus 12 control patients with chronic angina. At 6-week follow-up, in comparison to the control group, the treated group demonstrated significant increase in the exercise duration (P=0.03) and the time to angina (P=0.01); and a significant reduction in the incidence of anginal attacks and sublingual nitrate consumption (P=0.01) and in the incidence of ischemic episodes on 48-hour electrocardiogram (P=0.04). The ST segment depression on the exercise electrocardiogram decreased at comparable workload (P=0.01) with a significant increase in the perceived quality of life (P=0.03). Thus, the study concluded that spinal cord stimulation is an effective alternative the management of chronic intractable angina pectoris, and that its effect was exerted through anti-ischemic action.[1]
ACC/AHA Guidelines- Spinal Cord Stimulation (DO NOT EDIT)[2][3]
| “ |
Class IIb |
” |
Vote on and Suggest Revisions to the Current Guidelines
Sources
- The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [2]
- TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [3]
- Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [4]
- The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [5]
References
- ↑ Hautvast RW, DeJongste MJ, Staal MJ, van Gilst WH, Lie KI (1998) Spinal cord stimulation in chronic intractable angina pectoris: a randomized, controlled efficacy study. Am Heart J 136 (6):1114-20. PMID: 9842028
- ↑ 2.0 2.1 Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999)guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).Circulation 99 (21):2829-48. PMID: 10351980
- ↑ 3.0 3.1 Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58. PMID: 12515758
- ↑ Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). [url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 [1] "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology"] Check
|url=value (help). Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367. - ↑ Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72.[2] PMID: 17998462