Cost Effectiveness of Spinal Cord Stimulation in the Management of Severe Angina

  • M. Börjesson
  • C. Mannheimer
Conference paper


The majority of patients with angina pectoris often experience satisfactory pain relief through pharmacological treatment and/or surgery. Conventional medical management includes short-acting nitrates, beta-blockers, anticoagulants, angiotensin-converting enzyme inhibitors, long-acting nitrates, calcium-channel blockers and aspirin, whereas surgery includes coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). However, there is a group of patients that continues to suffer from lasting and severe and disabling angina pectoris despite optimum drug treatment and who are not suitable candidates for surgery. This condition has been defined as refractory angina pectoris [1].


Percutaneous Coronary Intervention Coronary Artery Bypass Grafting Angina Pectoris Spinal Cord Stimulation Canadian Cardiovascular Society 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Mannheimer C, Camici P, Chester MR et al (2002) The problem of chronic refractory angina; report from the ESC Joint Study Group on the Treatment of Refractory Angina. Eur Heart J 23: 355–370PubMedCrossRefGoogle Scholar
  2. 2.
    ACC/AHA (2007) Chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group. J Am Coll Cardiol 50: 2264–2274CrossRefGoogle Scholar
  3. 3.
    Melzack R, Wall PD (1965) Pain mechanisms: a new theory. Science 150: 971–979PubMedCrossRefGoogle Scholar
  4. 4.
    Shealy CN, Mortimer JT, Reswick JB (1967) Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg 46: 489–491PubMedGoogle Scholar
  5. 5.
    Simpson B (2003) Electrical stimulation and the relief of pain. Pain research and clinical management 15: 131–142Google Scholar
  6. 6.
    Mannheimer C, Carlsson CA, Ericsson K et al (1982) Transcutaneous electrical nerve stimulation in severe angina pectoris. Eur Heart J 3: 297–302PubMedGoogle Scholar
  7. 7.
    Mannheimer C, Carlsson CA, Emanuelsson H et al (1985) The effects of transcutaneous electrical nerve stimulation in patients with severe angina pectoris. Circulation 71: 308–316PubMedCrossRefGoogle Scholar
  8. 8.
    Emanuelsson H, Mannheimer C, Waagstein F et al (1987) Catecholamine metabolism during pacing-induced angina pectoris and the effect of transcutaneous electrical nerve stimulation. Am Heart Journal 114: 1360–1366CrossRefGoogle Scholar
  9. 9.
    Mannheimer C, Augustinsson LE, Carlsson CA et al (1988) Epidural spinal electrical stimulation in severe angina pectoris. Br Heart J 59: 56–61PubMedCrossRefGoogle Scholar
  10. 10.
    Murphy D, Gibs K (1987) Dorsal column stimulation for pain relief from intractable angina pectoris. Pain 28: 365–368PubMedCrossRefGoogle Scholar
  11. 11.
    Borjesson M, Andrell P, Lundberg D et al (2008) Spinal cord stimulation in severe angina pectoris- a systematic review based on the Swedish Council on Technology assessment in health care report on long-standing pain. Pain 140: 501–508PubMedCrossRefGoogle Scholar
  12. 12.
    Taylor RS, DeVries J, Buchser E et al (2009) Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomised controlled trials. BMC Cardiovasc Disord 9: 13PubMedCrossRefGoogle Scholar
  13. 13.
    Simpson EL, Dueras A, Holmes MW et al (2009) Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin: systematic review and economic evaluation. Health Technol Assess 13(17): iii, ix-x, 1–154Google Scholar
  14. 14.
    Yu W, Maru F, Edner M, Hellstrom K et al (2004) Spinal cord stimulation for refractory angina pectoris: a retrospective analysis of efficacy and cost-benefit. Coron Artery Dis 15: 31–37PubMedCrossRefGoogle Scholar
  15. 15.
    Mannheimer C, Eliasson T, Augustinsson LE et al (1998) Electrical stimulation versus coronary artery bypass surgery in severe angina pectoris: the ESBY study. Circulation 97: 1157–1163PubMedGoogle Scholar
  16. 16.
    Andrell P, Ekre O, Eliasson T et al (2003) Cost-effectiveness of spinal cord stimulation versus coronary artery bypass grafting in patients with severe angina pectoris - long-term results from the ESBY study. Cardiology 99: 20–24PubMedCrossRefGoogle Scholar
  17. 17.
    McNab D, Khan SN, Sharples LD et al (2006) An open label, single-centre, randomized trial of spinal cord stimulation vs. percutaneous myocardial laser revascularization in patients with refractory angina pectoris: The SPiRiT trial. Eur Heart J 27: 1048–1053PubMedCrossRefGoogle Scholar
  18. 18.
    Dyer MT, Goldsmith KA, Khan SN et al (2008) Clinical and cost-effectiveness analysis of an open label, single-centre, randomised trial of spinal cord stimulation (SCS) versus percutaneous myocardial laser revascularisation (PMR) in patients with refractory angina pectoris: The SPiRiT trial. Trials 9: 40PubMedCrossRefGoogle Scholar
  19. 19.
    Rawlins MD, Culver AJ (2004) National Institute for Clinical Excellence and its value judgements. Br Med J 329: 224–227CrossRefGoogle Scholar
  20. 20.
    Griffin SC, Barber JA, Manca A et al (2007) Cost effectiveness of clinically appropriate decisions on alternative treatments for angina pectoris: prospective observational study. Br Med J 334: 624 doi:  10.1136/bmj.39129.442164.5 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • M. Börjesson
  • C. Mannheimer

There are no affiliations available

Personalised recommendations