ABSTRACT
OBJECTIVE: Enhanced external counterpulsation (EECP) and ranolazine are approved treatments for patients with chronic stable angina by the United States Food and Drug Administration (FDA). Whether EECP offers clinical benefits regardless of underlying ranolazine therapy needs further investigation. METHODS: This was a retrospective evaluation of patients referred to a specialized EECP center. Patients having data on 6-Minute Walk Distance (6MWD) or Duke Activity Status Index (DASI) were categorized into two groups (EECP with ranolazine or EECP only). The primary endpoints were change in 6MWD and DASI before and after a full course of EECP within each of the two groups. Inter-group differences were also assessed. The Wilcoxon test was utilized to compare the change from baseline within each group and the Mann-Whitney U test to compare difference between groups. RESULTS: A total of 2836 patient records (age 66.9 ± 10 years) were identified (1193 in EECP and ranolazine group and 1643 in EECP only group). EECP added to baseline ranolazine resulted in a statistically significant improvement in 6MWD and DASI (+126 feet (IQR: 230 feet), and +13.35 (IQR: 17.11), respectively, P<0.001 for both). Similarly, the EECP only group showed a statistically significant improvement in 6MWD and DASI (+140 feet (IQR: 225 feet) and +13.49 (IQR: 18.02), respectively, P<0.001 for both). There was no statistically significant difference between the two groups when comparing the change from baseline in 6MWD and DASI score (P=0.256 and P=0.056 respectively). CONCLUSION: EECP improves markers of functional capacity regardless of baseline ranolazine therapy. EECP's unique safety profile advocates for its early consideration in the treatment algorithm.
