9. Which of the following statements is true regarding enhanced external counterpulsation (EECP)?

A. Exercise tolerance is improved with EECP

B. EECP  is considered first line therapy for stable angina

C. Patients undergoing EECP use less short acting nitrates

D. EECP reduces mortality in stable angina patients

E. EECP reduces the time to 1 mm ST depression on treadmill ECG testing

The MUST-EECP (enhanced external counterpulsation) trial randomized 139 outpatients with angina to EECP to therapeutic EECP versus non-therapeutic low pressure EECP. EECP subjectively decreased angina and time to 1 mm of ST depression on a treadmill ECG test. There were no adverse events and the treatment was well tolerated. There was no benefit in exercise tolerance or nitroglycerine use.

EECP is used in the outpatient setting in patients refractory to medical therapy. Compression cuffs are applied to the lower extremities and compressed air is applied during diastole (based on the ECG recording) to improve backward flow to the coronary arteries. This is similar to how an intraaortic balloon pump works hemodynamically.