Spinal Cord Stimulation for Long-term Treatment of Severe Angina Pectoris

What Does the Evidence Say?

Mats Börjesson; Paulin Andréll; Clas Mannheimer


Future Cardiol. 2011;7(6):825-833. 

In This Article


Future anticipated changes in lifestyle-related risk factors, new additional alternative therapeutic options as well as widened treatment indications, will affect the population of refractory angina patients, both in numbers and possibly in characteristics (more peripheral coronary artery disease in patients with diabetes). While treatment options will surely continue to improve in efficacy and lower the current pool of refractory patients, a growing number of new patients with refractory angina are anticipated, due to the increasing lifestyle related global atherosclerotic burden.

Thus, many patients in need of additional efficacious treatment options for severe, disabling angina will also be present in the future. There is scientific evidence for SCS giving rise to symptomatic benefits (decrease in anginal attacks) and improved quality of life, as well as improved functional status (improved exercise time on treadmill or longer walking distance without angina) in patients with severe angina pectoris.[35] In addition, limited data support that SCS does not seem to have any negative effects on mortality in patients with refractory angina pectoris with a low complication rate.[35]

While future studies regarding the effect of SCS on myocardial ischemia and heart failure might further enlarge the target population for SCS treatment, the most important future challenge may be to define the patient selection procedure and establish clear indications for SCS. Long-term efficacy studies and cost–effectiveness studies are needed to establish and to possibly move SCS up the treatment ladder of severe angina pectoris.


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