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J Am Coll Cardiol, 1999; 33:1833-1840
© 1999 by the American College of Cardiology Foundation
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CLINICAL STUDIES

The multicenter study of enhanced external counterpulsation (MUST-EECP): effect of EECP on exercise-induced myocardial ischemia and anginal episodes

Rohit R. Arora, MD*, Tony M. Chou, MD{dagger}, Diwakar Jain, MD{ddagger}, Bruce Fleishman, MD§, Lawrence Crawford, MD||, Thomas McKiernan, MD and Richard W. Nesto, MD#

* Columbia-Presbyterian Medical Center, Columbia University, New York, New York, USA
{dagger} University of California, San Francisco, California, USA
{ddagger} Yale University School of Medicine, New Haven, Connecticut, USA
§ Grant/Riverside Methodist Hospitals, Columbus, Ohio, USA
|| University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
Loyola University Medical Center, Maywood, Illinois; USA
# Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA for the MUST-EECP Investigators

Manuscript received November 3, 1998; revised manuscript received January 27, 1999, accepted March 1, 1999.

Reprint requests and correspondence: Dr. Richard W. Nesto, Cardiovascular Division, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, Massachusetts 02215
rnesto{at}caregroup.harvard.edu

OBJECTIVES

The purpose of this study was to assess safety and efficacy of enhanced external counterpulsation (EECP).

BACKGROUND

Case series have shown that EECP can improve exercise tolerance, symptoms and myocardial perfusion in stable angina pectoris.

METHODS

A multicenter, prospective, randomized, blinded, controlled trial was conducted in seven university hospitals in 139 outpatients with angina, documented coronary artery disease (CAD) and positive exercise treadmill test. Patients were given 35 h of active counterpulsation (active CP) or inactive counterpulsation (inactive CP) over a four- to seven-week period. Outcome measures were exercise duration and time to ≥1-mm ST-segment depression, average daily anginal attack count and nitroglycerin usage.

RESULTS

Exercise duration increased in both groups, but the between-group difference was not significant (p > 0.3). Time to ≥1-mm ST-segment depression increased significantly from baseline in active CP compared with inactive CP (p = 0.01). More active-CP patients saw a decrease and fewer experienced an increase in angina episodes as compared with inactive-CP patients (p < 0.05). Nitroglycerin usage decreased in active CP but did not change in the inactive-CP group. The between-group difference was not significant (p > 0.7).

CONCLUSIONS

Enhanced external counterpulsation reduces angina and extends time to exercise-induced ischemia in patients with symptomatic CAD. Treatment was relatively well tolerated and free of limiting side effects in most patients.

Abbreviations and Acronyms
  CABG = coronary artery bypass grafting
  CAD = coronary artery disease
  CP = counterpulsation
  EECP = enhanced external counterpulsation
  ETT = exercise treadmill test
  MI = myocardial infarction
  MUST = multicenter study
  NO = nitric oxide
  NTG = nitroglycerin




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