Spinal Cord Stimulation for Refractory Angina Pectoris
Summary
Refractory angina pectoris describes chronic chest pain in patients with advanced coronary artery disease who remain symptomatic despite optimal medical therapy and lack further revascularisation options. Spinal cord stimulation (SCS) has emerged as an adjunctive neuromodulation approach in this setting, involving implantation of epidural electrodes that deliver controlled electrical pulses to dorsal column fibres. Modulation of central nociceptive pathways and autonomic efferents is thought to diminish pain perception and may enhance myocardial perfusion. Over the past three decades, clinical experience has demonstrated reductions in angina frequency, decreased reliance on short-acting nitrates and meaningful improvements in health-related quality of life. Low rates of device-related complications, combined with favourable medium-term cost profiles, have positioned SCS as a viable therapeutic route for patients unsuitable for further percutaneous or surgical interventions. Advances in waveform technology, image-guided lead placement and multidisciplinary patient selection continue to refine outcomes, underscoring the global relevance of SCS in comprehensive chronic angina management.
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Spinal Cord Stimulation for Refractory Angina Pectoris publication trend
The graph below shows the total number of articles in spinal cord stimulation for refractory angina pectoris across all publications each year (not limited to Nature Index journals).
Technical terms
Spinal cord stimulation (SCS): A neuromodulation technique delivering electrical pulses to dorsal spinal cord fibres to alleviate chronic pain.
Refractory angina pectoris (RAP): Persistent myocardial ischaemic chest pain unresponsive to optimal medical therapy and unsuitable for further revascularisation.
Seattle Angina Questionnaire (SAQ): A validated patient-reported instrument measuring angina frequency, physical limitation and quality of life in coronary disease.
Myocardial ischaemia: A pathological state of reduced coronary blood flow leading to oxygen supply–demand imbalance in heart muscle.
Cross-over design: A clinical trial structure in which participants receive sequential interventions, serving as their own controls to enhance statistical power.
References
- Long-term efficacy and safety of spinal cord stimulation in patients with refractory angina pectoris. IJC Heart & Vasculature (2023).
- Design and rationale of the efficacy of spinal cord stimulation in patients with refractory angina pectoris (SCRAP) trial. Clinical Cardiology (2023).
- Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomised controlled trials. BMC Cardiovascular Disorders (2009).
- 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 (2008).
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