Evaluering av behandling med ryggmargsstimulator hos pasienter med refraktær angina pectoris

Abstract

Abstract

Background There are different treatments available for patients with ischemic heart disease. Pharmacological treatment, PCI (percutaneous coronary interventions) and CABG (coronary artery bypass grafting) surgery are the most common. Unfortunately, some patients have persistent pain and symptoms although they have tried all these different treatment regimes. Spinal cord stimulation has been shown to have a positive effect on pain and quality of life in patients with intractable angina. At Aker University Hospital this treatment is being offered. This project was performed to evaluate the effect of spinal cord stimulation (SCS).

Methods All patients who had had a SCS surgery at Aker University Hospital were initially approached. We sought to evaluate quality of life by using questionnaires asking about activity of daily life, physical and psychological health, and quality of life. We used two different forms; Seattle Angina Questionnaire and SF-36 Health assessment. 7 patients answered the SF-36 before and after surgery, and we performed a comparison between these.

Results All over the patients seemed to be content with the treatment. We found very few complications. In one of the patients one of the electrodes broke, and one patient had an superficial infection. Most of the patients had not altered their medications, but reduced the intake of glyceryl trinitrate. Daily activities like getting dressed and walk inside were not a common problem, but they all had trouble when the activity was harder like doing sports or carry heavy loads. In the comparison before and after implantation we could document that most people found that their health had indeed become better after the surgery. Particularly they reported increased exercise capacity, less restrictions in daily activities and improved social life. This together with the reduced intake of glyceryl trinitrate shows an improvement in quality of life.

Conclusions Spinal cord stimulation seems to be able to improve exercise capacity and quality of life. Our project encompasses only few patients, and hence can not provide statistically robust analyses. Nevertheless the comparison of exercise capacity before and after SCS implantation, as well as reduced NTG-use, suggests favourable effects.