Decker, K. de (Koen) (2013) Evolving predictors of outcome measures in the treatment of refractory angina pectoris with implantable neuromodulation devices. thesis, Medicine.
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Abstract
Introduction: Patients with refractory angina pectoris do not benefit from conventional therapies anymore and are often severely restricted in performing daily activities. Therefore, patients’ quality of life (QOL) is often deteriorated. Electrical neuromodulation, in the sense of spinal cord stimulation (SCS) or subcutaneous electrical nerve stimulation (SENS), can be considered as a good adjuvant therapy for these patients. However, there are patients who do not have any benefits of this electrical stimulation. The aim of the present retrospective study was to assess patients’ survival and stimulation time, to evaluate the efficacy of both modalities and to determine whether certain baseline characteristics affect the therapy outcome. Furthermore, patients QOL was examined and a comparison of both modalities, concerning the efficacy and neurostimulator settings, was also one of the objectives. Materials and methods: All patients who were implanted with a SCS or SENS system were included in our neuromodulation database. Of the deceased patients, only a limited amount of data (e.g. gender, age and survival time after implantation) was known and with regard to the patients who were alive, several baseline characteristics, for instance, length, weight, ECG rhythm and exercise capacity, were collected. Follow-up variables, for example, the outcome of therapy, months of stimulation and whether a patient is still stimulating, are also recorded in the database. In the case of the SENS patients, QOL scores were measured with the Seattle Angina Questionnaire (SAQ). Results: In total, 130 SCS and 15 SENS patients were included in the database. Out of 130 SCS patients, 56 were further analysed, 1 was lost to follow-up en 73 deceased, with a mean survival of 93.4 months. There was no difference between men and women in terms of survival time (p=0.690) and the number of deceased patients (p=0.168). A Kaplan-Meier analysis has shown a mean estimated survival and stimulation time of 153.2 (n=130) and 130.0 (n=53) months, respectively, with again no differences as a result of gender (p=0.741 and p=0.678). In case of the living SCS patients, there was no significant improvement of exercise capacity and left ventricular ejection fraction after one year. Though, there was a significant improvement of CCS classification (p<0.001). Regression analyses have shown that a lateral myocardial infarction at baseline is associated with the lack of a positive outcome. Moreover, the use of oxazepam and the number of myocardial infarctions are associated with a moderate instead of an excellent effect. With respect to the SENS patients, 1 patient was lost to follow-up and an improvement of exercise capacity (p=0.019), CCS classification (p=0.001) and QOL scores was observed with regard to the remaining patients. After comparing both modalities (SCS and SENS), it has been shown that there are no significant differences between the proportions of patients with a positive outcome (p=0.194) and the same applies to a moderate or excellent effect (p=0.740). Conclusion: Both the SCS as the SENS patients showed a significant improvement of their symptoms following electrical neuromodulation (CCS classification). In the case of SENS patients an improvement of exercise capacity and QOL scores was also observed. Furthermore, some baseline characteristics (including a lateral myocardial infarction, use of oxazepam and the number of myocardial infarctions) are associated with the outcome of SCS, which could be taken into account when electrical neuromodulation is indicated. No substantial outcome differences were observed after comparison of both modalities. Due to the fact that the interesting results and subsequent conclusions are based on a limited number of patients, these findings should be further investigated in a larger group of patients, preferably by means of a prospective multicentre study.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty Supervisor: and de Jongste, Dr. M.J.L. and cardiologist and Institution: University Medical Center Groningen and Department: Cardiology |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:43 |
| Last Modified: | 25 Jun 2020 10:43 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/456 |
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