The Role of Enhanced External Counterpulsation Therapy in the Management of Coronary Artery Disease

Coronary artery disease (CAD) is a narrowing or blockage of the arteries and vessels that provide oxygen and nutrients to the heart. It is caused by atherosclerosis, an accumulation of fatty materials on the inner linings of arteries. According to the American Heart Association and American Stroke Association's 2010 publication on heart disease and stroke statistics, cardiovascular disease remains the leading cause of mortality in the United States in men and women of every major ethnic group. It accounts for nearly 1 million deaths per year as of 2006 and was responsible for one in almost three deaths in the United States in 2006. Approximately 17 million persons have a history of coronary artery disease and 8 million have suffered a myocardial infarction (American Heart Association 2010). Medication and invasive revascularization are the most common approaches for treating CAD. Invasive revascularization includes percutaneus coronary interventions (PCI: stent implantation or balloon angioplasty)and Coronary Bypass Surgery (CABG). Even though both treatment options are commonly used, it is important to note that neither of these approaches provides a cure. In other words, although the symptoms are eliminated or alleviated, the disease and its causes are still present after treatment. Both treatments target lesions that cause the obstructions however, CAD is a progressive disease. New treatment approaches are in need to prevent the disease from progressing and the symptoms from recurring. Enhanced External Counterpulsation (EECP) therapy with its different mode of action provides a new treatment modality in the management of CAD and complements the invasive revascularization (Fig. 1). This chapter summarizes the current evidence to support the role of EECP therapy in CAD management and provides information on its mechanism of action.