| BackgroundCoronary atherosclerotic heart disease, namely coronary heart disease (CHD), and it was also called ischemic heart disease. It was defined as a heart disease result from myocardial ischemia and anoxia injure due to the coronary artery stenosis and blocking by coronary atherosclerosis, and it was the most common type lead to organ lesion. With the population aging, the intake of high cholesterol foods and the progress of modern medical technology, life was prolonged in the group of population who suffered from coronary heart events, and it leaded to the prevalence of chronic coronary diseases increasing year by year. All of these resulted in the incidence of angina increasing in patient with cardiovascular diseases. The common symptoms of these group patients were appearing squeeze and suffocating pain located in the upper-middle of gladiolus after tired. With the development of the disease, it will severely affect the life, work and study of the patients by the frequent seizure frequency and the extension of duration. Although these patients have been already given optimal medical management by the guideline (i.e.β-blockers, calcium channel blockers, and long-acting nitrates) and coronary revascularization, it was still a severe challenge for the management of the patients with intractable angina who were unresponsive to medical therapy and not candidate for coronary revascularization.Refractory angina pectoris (RAP) was the most dangerous clinical syndrome in coronary heart disease terminal phase. It reduced exercise capacity and increased the risk of myocardial infraction in patients, so the correct treatment strategies were not only relieve the symptoms of angina pectoris but also reduce the incidence of cardiovascular events. It has a great significance to help to improve the prognosis of patients and improve the quality of life as well. The current therapies including:the new medicines, percutaneous myocardial laser revascularization, reduce coronary sinus, angiogenesis factor and gene therapy. Currently, a single-center clinical trial suggested Enhanced External Counterpulsation (EECP) has been verified a non-invasive and safe treatment for RAP. Due to the sample size is small of the independent study, it will hard to obtain a certain conclusion. It yet has been a controversy whether the EECP can largely apply to clinical practice.ObjectiveOur meta-analysis evaluated the efficacy of EECP in patients with RAP on Canadian Cardiovascular Society (CCS) Angina Class though identified relative literatures, which have been published. So the results can provide Evidenced Based Medicine in clinical for physicians.MethodsWe identified systematic literature though MEDLINE, EMBASE, the Cochrane Clinical Trials Register Database and the ClinicalTrials.gov Website from 1990 to 2015. Language restrictions were not applied. Studies were considered eligible if they were conform to inclusion and exclusion criteria, and the data were extracted based on the standardized form. We used the Metaprop module in the R version 3.1.3 statistical software package to statistical analysis. The effect was the pooled proportion and 95% Confidence Interval (CI), statistical heterogeneity was calculated by I2 statistic and the Q statistic. Sensitivity analysis was addressed to test the influence of trials on the overall pooled results and subgroup analysis was applied to explore potential reasons for heterogeneity.ResultsIn the initial 762 literatures,18 studies that conform to the inclusion criteria were enrolled in our meta-analysis. Pooled analysis suggested 85% of patients underwent EECP had a reduction by at least one CCS class (95%CI 0.81-0.88,I2=58.5%, p< 0.001). The patients enrolling at primarily different studies with CHF had improved about 84% after EECP (95%CI 0.81-0.88,I2=32.7%,p=0.1668). After three large studies excluded, the pooled proportion was 82%(95%CI 0.79-0.86,I2=18%, p=0.2528). Begg funnel plot indicated some asymmetry but the Begg and Egger bias statistic showed no publication bias (p=0.1495 and 0.2859, respectively). It suggested that our study have a better control for the publication bias.ConclusionsEECP therapy can evidently improve the symptom of the patients with RAP, and reduce the CCS class. EECP, as a supplementary treatment, can provide a safe and effective therapy for the patients with chronic RAP who were unresponsive to medicine treatment or not suitable for invasive therapy. But, the long-term benefits of EECP therapy for this group patients needed large-scale clinical randomized controlled studies to verify. |
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