• Holger Diedrichs, Michael Weber, Eberhard Voth, Atanasios Koulousakis, Carsten Zobel, and Robert H G Schwinger.
• Klinik III für Innere Medizin, Universität zu Köln, Cologne. Holger.Diedrichs@uni-koeln.de
• Med Klin. 2003 Mar 15;98(3):146-50.

BackgroundIn spite of great progresses in surgical and catheter interventional techniques there is an increasing number of patients with coronary heart disease not suitable for these conventional treatment strategies.TherapyA recent review of the Study Group on the treatment of refractory angina pectoris of the European Society of Cardiology (ESC) recommends spinal cord stimulation (SCS) as first-line therapy. SCS is a well-known and often used therapy for refractory angina in other European countries but not in Germany. The present studies show that SCS is an efficient therapy. By reduction of angina symptoms and a consecutive increase of exercise capacity, the patients experience a great improvement in quality of life. In addition, recent data of our own study suggest a significant decrease in myocardial ischemia in patients under SCS. This might be a direct effect of SCS or due to a better collateralization because of the improved exercise capacity.ConclusionIn agreement with the study group of the ESC, we would recommend SCS as first-line therapy for refractory angina pectoris. As a matter of course, conventional treatment strategies should not be replaced by SCS. Hence, a strict evaluation before implanting a SCS device is indispensable.

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