Management of Patients With Refractory Angina: Canadian Cardiovascular Society/Canadian Pain Society Joint Guidelines Michael McGillion, RN, PhD, Heather.

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Presentation transcript:

Management of Patients With Refractory Angina: Canadian Cardiovascular Society/Canadian Pain Society Joint Guidelines Michael McGillion, RN, PhD, Heather M. Arthur, PhD, FESC, Allison Cook, RN, BScN, Sandra L. Carroll, PhD, J. Charles Victor, MSc, Philippe L. L'Allier, MD, FRCPC, E. Marc Jolicoeur, MD, MSc, MHS, FACC, FCRPC, Nelson Svorkdal, MD, FRCPC, Joel Niznick, MD, FRCPC, Kevin Teoh, MD, MSc, FRCSC, Tammy Cosman, RN(EC), PhD, Barry Sessle, PhD, Judy Watt-Watson, RN, PhD, Alexander Clark, RN, PhD, Paul Taenzer, PhD, Peter Coyte, PhD, Louise Malysh, RN, MN, Carol Galte, RN, MN, James Stone, MD, PhD, FRCPC, FAACVPR, FACC Canadian Journal of Cardiology Volume 28, Issue 2, Pages S20-S41 (March 2012) DOI: 10.1016/j.cjca.2011.07.007 Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 1 Comparison of transmyocardial laser revascularization vs medical treatment, outcome Canadian Cardiovascular Society (CCS) class. CI, confidence interval; df, degree of freedom; M-H, Mantel-Haenszel; NYHA, New York Heart Association. Reproduced from Briones et al.49 Copyright © 2009 Cochrane Collaboration, reproduced with permission. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 2 Comparison of transmyocardial laser revascularization vs medical treatment, outcome Seattle Angina Questionnaire-physical limitation. CI, confidence interval; df, degree of freedom; IV, inverse variance; SD, standard deviation. Reproduced from Briones et al.49 Copyright © 2009 Cochrane Collaboration, reproduced with permission. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 3 Comparison of transmyocardial laser revascularization vs medical treatment, outcome exercise tolerance. CI, confidence interval; df, degree of freedom; IV, inverse variance; SD, standard deviation. Reproduced from Briones et al.49 Copyright © 2009 Cochrane Collaboration, reproduced with permission. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 4 Comparison of transmyocardial laser revascularization vs medical treatment, outcome early postoperative mortality (as treated). CI, confidence interval; df, degree of freedom; M-H, Mantel-Haenszel. Reproduced from Briones et al.49 Copyright © 2009 Cochrane Collaboration, reproduced with permission. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 5 Comparison of percutaneous myocardial laser revascularization vs maximal medical therapy, outcome Canadian Cardiovascular Society class. CI, confidence interval; df, degree of freedom; IV, inverse variance; LD, low dose; SD, standard deviation. Reprinted from McGillion et al.,54 © 2010, with permission from Dove Medical Press Ltd. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 6 Comparison of percutaneous myocardial laser revascularization vs maximal medical therapy, outcome Seattle Angina Questionnaire-angina frequency. CI, confidence interval; df, degree of freedom; IV, inverse variance; LD, low dose; SD, standard deviation. Reprinted from McGillion et al.,54 © 2010, with permission from Dove Medical Press Ltd. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 7 Comparison of percutaneous myocardial laser revascularization vs maximal medical therapy, outcome Seattle Angina Questionnaire-disease perception. CI, confidence interval; df, degree of freedom; IV, inverse variance; LD, low dose; SD, standard deviation. Reprinted from McGillion et al.,54 © 2010, with permission from Dove Medical Press Ltd. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 8 Comparison of percutaneous myocardial laser revascularization vs maximal medical therapy, outcome Seattle Angina Questionnaire-physical limitation. CI, confidence interval; df, degree of freedom; IV, inverse variance; LD, low dose; SD, standard deviation. Reprinted from McGillion et al.,54 © 2010, with permission from Dove Medical Press Ltd. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 9 Comparison of percutaneous myocardial laser revascularization vs maximal medical therapy, outcome Seattle Angina Questionnaire-angina severity. CI, confidence interval; df, degree of freedom; IV, inverse variance; LD, low dose; SD, standard deviation. Reprinted from McGillion et al.,54 © 2010, with permission from Dove Medical Press Ltd. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 10 Comparison of percutaneous myocardial laser revascularization vs maximal medical therapy, outcome Seattle Angina Questionnaire-treatment satisfaction. CI, confidence interval; df, degree of freedom; IV, inverse variance; LD, low dose; SD, standard deviation. Reprinted from McGillion et al.,54 © 2010, with permission from Dove Medical Press Ltd. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 11 Comparison of percutaneous myocardial laser revascularization vs maximal medical therapy, outcome exercise performance. CI, confidence interval; df, degree of freedom; IV, inverse variance; LD, low dose; SD, standard deviation. Reprinted from McGillion et al.,54 © 2010, with permission from Dove Medical Press Ltd. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 12 Comparison of percutaneous myocardial laser revascularization vs maximal medical therapy, outcome all-cause mortality. CI, confidence interval; df, degree of freedom; IV, inverse variance; LD, low dose; SD, standard deviation. Reprinted from McGillion et al.,54 © 2010, with permission from Dove Medical Press Ltd. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 13 Comparison of SCS vs controls, outcome exercise capacity, between-group difference. CABG, coronary artery bypass grafting; CI, confidence interval; df, degree of freedom; ESBY, Electrical Stimulation vs Coronary Artery Bypass Surgery in Severe Angina Pectoris study; IV, inverse variance; PMR, percutaneous myocardial laser revascularization; SCS, spinal cord stimulation; SD, standard deviation; SPiRiT, Spinal Cord Stimulation vs Percutaneous Myocardial Laser Revascularization in Patients With Refractory Angina Pectoris Trial. Reproduced from Taylor et al.81 with permission granted under BioMed Central's general open access terms. © 2009 Taylor et al; licensee BioMed Central Ltd. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 14 Comparison of SCS vs controls, outcome health-related quality of life, between-group difference. Based on NHP Part 1 score for ESBY 1993;87 SF-36 physical health scale at 2 years for SPiRiT 2006;88 ADL score for DeJongste 1994,86 EQ-5D VAS score for Eddicks 2007;83 LASA score for Hautvast 1998.85 ADL, Activities of Daily Living; CABG, coronary artery bypass grafting; CI, confidence interval; df, degree of freedom; EQ-5D VAS, EuroQol 5 Dimensions Visual Analogue Scale; ESBY, Electrical Stimulation vs Coronary Artery Bypass Surgery in Severe Angina Pectoris study; IV, inverse variance; LASA, Linear Analogue Self-Assessment; NPH, Nottingham Health Profile; PMR, percutaneous myocardial laser revascularization; SCS, spinal cord stimulation; SD, standard deviation; SF-36, Medical Outcomes Study Short Form-36; SPiRiT, Spinal Cord Stimulation vs Percutaneous Myocardial Laser Revascularization in Patients With Refractory Angina Pectoris Trial. Reproduced from Taylor et al.81 with permission granted under BioMed Central's general open access terms. © 2009 Taylor et al; licensee BioMed Central Ltd. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 15 Enhanced external counter-pulsation: comparison of pre- vs post-treatment, outcome Seattle Angina Questionnaire-anginal stability. CI, confidence interval; df, degree of freedom; IV, inverse variance; SE, standard error. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 16 Comparison of self-management training with controls, outcome frequency of angina episodes per week. CI, confidence interval. Modified and reproduced from McGillion et al.132 with permission from Bentham Science Publishers Ltd. © 2008 Bentham Science Publishers Ltd. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 17 Comparison of self-management training with controls, outcome sublingual nitrate usages per week. CI, confidence interval. Modified and reproduced from McGillion et al.132 with permission from Bentham Science Publishers Ltd. © 2008 Bentham Science Publishers Ltd. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 18 Comparison of self-management training with controls, outcome Seattle Angina Questionnaire-physical limitation. CI, confidence interval. Modified and reproduced from McGillion et al.132 with permission from Bentham Science Publishers Ltd. © 2008 Bentham Science Publishers Ltd. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions

Figure 19 Comparison of self-management training with controls, outcome Seattle Angina Questionnaire-disease perception. CI, confidence interval. Modified and reproduced from McGillion et al.132 with permission from Bentham Science Publishers Ltd. © 2008 Bentham Science Publishers Ltd. Canadian Journal of Cardiology 2012 28, S20-S41DOI: (10.1016/j.cjca.2011.07.007) Copyright © 2012 Canadian Cardiovascular Society Terms and Conditions