Original articleEffect of Long-Term Thoracic Epidural Analgesia on Refractory Angina Pectoris: A 10-Year Experience
Section snippets
Methods
The authors recorded data prospectively on 152 consecutive patients with refractory angina pectoris as defined previously who, after they had given informed consent, began treatment with TEA between January 1998 and August 2007. The study complied with the Declaration of Helsinki and was approved by the local ethics committee. Patients with dementia or who were unable to handle the syringes for epidural injections were excluded. Data were collected until August 2008, and the follow-up for each
Results
Of the 152 patients, 145 (95%) estimated that the treatment had been beneficial. Figure 1 shows the changes in CCS angina class because of treatment. There was a significant improvement after 1 to 2 weeks compared with baseline (the median IQR) for CCS angina class before TEA was 4.0 (3.0-4.0) and after 1 to 2 weeks it was 2.0 (1.0-2.0), p < 0.001). This improvement was maintained throughout the follow-up (for up to 6 years, p < 0.001 at all visits compared with baseline). The number of
Discussion
To the authors' knowledge, this is the 1st prospective study of the effects of long-term TEA on angina pectoris and quality of life in patients with refractory angina who are unresponsive to maximal medical therapy and are not eligible for conventional revascularization. The main finding was that TEA substantially improved the symptoms of angina and the quality of life within a week of the start of treatment, and this improvement was maintained throughout a follow-up period of 9 years
Acknowledgment
This study was made possible thanks to the work of research nurses Lena Wind, Shayesteh Dehestani, and Elisabeth Logander, Department of Cardiology, University Hospital, Linköping. The authors thank Hans Rutberg, MD, PhD, and Sture Blomberg, MD, PhD, for their enthusiastic support during the start of the study.
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Supported by grants from the Research Board of the County Council of Östergötland, Östergötland, Sweden.