From the Multidisciplinary Pain Centre (C.M., T.E., H.N.), Department of
Medicine, Östra Hospital and the Departments of Neurosurgery (L.-E.A.),
Neurology (C.B.), Cardiology (H.E., A.H.), and Thoracic Surgery (S.L.),
Sahlgren's Hospital, Gothenburg, Sweden.
Background—Spinal cord stimulation
(SCS) has been shown to have antianginal and anti-ischemic
effects in severe angina pectoris. The present study was performed
to investigate whether SCS can be used as an alternative to
coronary artery bypass grafting (CABG) in selected patient
groups, ie, patients with no proven prognostic benefit from CABG and
with an increased surgical risk.
Methods and Results—One hundred four patients were randomized
(SCS, 53; CABG, 51). The patients were assessed with respect to
symptoms, exercise capacity, ischemic ECG changes during
exercise, rate-pressure product, mortality, and
cardiovascular morbidity before and 6 months after the
operation. Both groups had adequate symptom relief
(P<.0001), and there was no difference between SCS and
CABG. The CABG group had an increase in exercise capacity
(P=.02), less ST-segment depression on maximum
(P=.005) and comparable (P=.0009)
workloads, and an increase in the rate-pressure product both at
maximum (P=.0003) and comparable (P=.03)
workloads compared with the SCS group. Eight deaths occurred during the
follow-up period, 7 in the CABG group and 1 in the SCS group. On an
intention-to-treat basis, the mortality rate was lower in the SCS group
(P=.02). Cerebrovascular morbidity was also lower in the
SCS group (P=.03).
Conclusions—CABG and SCS appear to be equivalent methods in terms
of symptom relief in this group of patients. Effects on
ischemia, morbidity, and mortality should be considered in the
choice of treatment method. Taking all factors into account, it seems
reasonable to conclude that SCS may be a therapeutic alternative for
patients with an increased risk of surgical complications.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Electrical Stimulation Versus Coronary Artery Bypass Surgery in Severe Angina Pectoris
The ESBY Study
Key Words: bypass • angina • electrical stimulation
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