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Long-term effects of spinal cord stimulation on angina symptoms and quality of life in patients with refractory angina pectoris—results from the European Angina Registry Link Study (EARL)
  1. P Andréll1,
  2. W Yu2,
  3. P Gersbach3,
  4. L Gillberg4,
  5. K Pehrsson5,
  6. I Hardy6,
  7. A Ståhle7,
  8. C Andersen8,
  9. C Mannheimer1
  1. 1Multidisciplinary Pain Center, Institute of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
  2. 2Department of Internal Medicine, Capio, St Göran Hospital, Stockholm, Sweden
  3. 3Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  4. 4Department of Anaesthesiology, Central Hospital, Kristianstad, Sweden
  5. 5Department of Cardiology, Karolinska University Hospital/Solna, Stockholm, Sweden
  6. 6Department of Anaesthesia, Papworth Hospital NHS Trust, Papworth, UK
  7. 7Deparemtnet of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Stockholm, Sweden
  8. 8Department of Cardiothoracic Anaesthesia, Odense University Hospital, Odense, Denmark
  1. Correspondence to Dr Paulin Andréll, Multidisciplinary Pain Center, Sahlgrenska University Hospital/Östra, SE-416 85 Göteborg, Sweden; paulin.andrell{at}


Objective To assess the long-term effect of spinal cord stimulation (SCS) on angina symptoms and quality of life in patients with refractory angina pectoris defined as severe angina due to coronary artery disease resistant to conventional pharmacological therapy and/or revascularisation.

Methods During 2003–2005, all patients with refractory angina referred for SCS treatment at 10 European centres were consecutively included in the European registry for refractory angina (European Angina Registry Link, EARL), a prospective, 3-year follow-up study. In the present study, the SCS-treated patients were followed-up regarding angina symptoms and quality of life assessed was with a generic (Short Form 36, SF-36) and a disease-specific (Seattle Angina Questionnaire, SAQ) quality of life questionnaire.

Results In total, 235 patients were included in the study. After screening, 121 patients were implanted and followed up 12.1 months after implantation. The implanted patients reported fewer angina attacks (p<0.0001), reduced short-acting nitrate consumption (p<0.0001) and improved Canadian Cardiovascular Society class (p<0.0001). Furthermore, quality of life was significantly improved in all dimensions of the SF-36 and the SAQ. Seven (5.8%) of the implanted patients died within 1 year of follow up.

Conclusions SCS treatment is associated with symptom relief and improved quality of life in patients with refractory angina pectoris suffering from severe coronary artery disease.

  • ngina pectoris
  • mortality
  • quality of life
  • spinal cord stimulation
  • angina treatment
  • coronary artery disease (CAD)
  • stable angina

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  • Funding The study was sponsored by Medtronic Europe.

  • Competing interests None.

  • Ethics approval The study protocol was approved by the local Ethics Committees at all centres:

    Sweden: Göteborg, Lund/Malmö, Stockholm, Uppsala, Örebro, Umeå;

    Denmark: Vejle and Fyens conties;

    United Kingdom: Cambridge (South West Multi-centre Research Ethics Committee);

    Norway: Helseregion Midt Norge; Switzerland: Lausanne.

  • Provenance and peer review Not commissioned; externally peer reviewed.