SPINAL-CORD STIMULATION IN ANGINA-PECTORIS WITH NORMAL CORONARY ARTERIOGRAMS

Background: Patients with angina pectoris with normal coronary arteriograms, also known as Syndrome X (typical exercise-induced angina pectoris, positive exercise testing, and normal coronary arteriograms), are often difficult to treat with conventional forms of medical therapy. Spinal cord stimulation has been used in recent years for the treatment of severe angina pectoris refractory to conventional medical and surgical therapy in coronary artery disease. The aim of this study was to investigate the effects of spinal cord stimulation on angina pectoris with normal coronary arteriograms. Methods: Twelve patients underwent five bicycle exercise tests, three tests without (control), and two tests with spinal cord stimulation treatment. Results: The exercise tolerance of the patients increased (108 +/- 22 W versus 96 +/- 21 W; P< 0.001), the magnitude of ST-segment depression at comparable work load decreased (1.0 +/- 0.6 mm versus 1.5 +/- 0.9 mm; P < 0.01), time to angina increased (5.4 +/- 2.2 min versus 2.7 +/- 1.9 min; P < 0.01), and time to the appearance of ST-segment depression increased (3.5 +/- 1.9 min versus 2.4 +/- 1.6 min; P < 0.01).The rate-pressure product at maximum work load during treatment increased, compared with the maximum work load during the control session (28 038 +/- 6124 mmHg x bpm versus 25 222 +/- 4519 mmHg x bpm; P < 0.05 ) and the comparable work load during treatment (28 038 +/- th 6124 mmHg x bpm versus 24 795 +/- 5022 mmHg x bpm; P < 0.01). Conclusions: Spinal cord stimulation has beneficial effects in angina pectoris with normal coronary arteriograms in terms of relief of symptoms of angina pectoris and improvement of exercise tolerance. These effects may be associated with a reduction in myocardial ischemia.