Spinal cord stimulation for angina pectoris
Alan Merry
Department of Anaesthesiology, University of Auckland
A significant number of patients are not helped by, or are not candidates for, conventional treatments for angina pectoris. Spinal cord stimulation (SCS) appears to be effective in about 80% of patients. By 1995, more than 700 patients with angina had been treated world-wide with SCS. Although the mechanisms of action of SCS remain incompletely understood, an anti-ischaemic effect is involved.
SCS has been used for chronic pain in the multidisciplinary Auckland Regional Pain Service for over ten years, and for intractable angina pectoris since 1997. Results have been encouraging, but SCS is a costly procedure (NZ$13,300 for the implanted components alone), and expense is a major impediment to the implementation of any programme of SCS. We have published data from a review of the cost of healthcare utilisation by eight sequential patients suffering from intractable angina unsuitable for coronary revascularization, before and after treatment with SCS at GLH. Extrapolation of the pooled data for all eight patients suggested that, on average, the cost of implanting a SCS would be recovered in approximately 15 months. With caveats, we concluded that SCS appeared to be a cost-effective treatment for intractable angina pectoris. In addition, there may be a case for offering SCS to patients in whom surgery is feasible but high risk. Recently we have treated several such patients with SCS, with encouraging results.
Time of Presentation
Saturday 7 May 2005 - 1030-1200
