EECP Evidence — EECC MCQ

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ModerateCoronary Artery DiseaseEECP EvidenceEECC

A 62-year-old man with stable CCS on maximal medical therapy is considered for enhanced external counterpulsation (EECP). What is EECP and what evidence supports its use?

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Correct answer: B — Use EECP for refractory angina

Enhanced external counterpulsation (EECP) is a non-invasive outpatient treatment using three pairs of pneumatic cuffs on the calves, thighs, and buttocks that sequentially inflate during diastole (augmenting coronary perfusion pressure) and deflate during systole (reducing afterload). Standard protocol: 35 one-hour sessions over 7 weeks. The MUST-EECP trial (sham-controlled) demonstrated increased exercise tolerance and reduced angina frequency. Proposed mechanisms: (1) improved endothelial function (increased NO, reduced endothelin); (2) enhanced collateral flow; (3) arteriogenesis. The 2024 ESC CCS Guidelines include EECP as a Class IIb recommendation for refractory angina in patients not amenable to revascularisation. It is non-invasive, safe, and can be repeated. Contraindications: severe PAD, DVT, severe AR, and pregnancy.

Reference: ESC (2024): CCS Guidelines; MUST-EECP Trial: https://bnf.nice.org.uk/