What the research shows.

• Soran et al. 2006In an analysis of the international EECP registry, a collection of treatment data from many centres, of 363 patients with refractory angina and severely reduced pump function, angina improved from severe to none or mild in 72 percent, and 52 percent no longer needed nitroglycerin afterwards. After two years the improvement was maintained in 55 percent.

  Soran O, Kennard ED, Kfoury AG, Kelsey SF; IEPR Investigators. Two-year clinical outcomes after EECP in refractory angina and left ventricular dysfunction. Am J Cardiol. 2006;97(1):17–20. PMID 16377276

• Arora et al. 1999The blinded, sham-controlled MUST-EECP trial at seven university hospitals with 139 patients with documented coronary artery disease showed fewer angina episodes and a longer time to exercise-induced ischaemia.

  Arora RR, Chou TM, Jain D, et al. The Multicenter Study of Enhanced External Counterpulsation (MUST-EECP). J Am Coll Cardiol. 1999;33(7):1833–1840. PMID 10362181

• Feldman et al. 2006The randomised PEECH trial of 187 patients with mild to moderate heart failure showed, after six months, more frequently a longer exercise duration (35 versus 25 percent), a lower breathlessness rating (NYHA class) and more quality of life. Peak oxygen uptake did not change.

  Feldman AM, Silver MA, Francis GS, et al. Enhanced external counterpulsation improves exercise tolerance in patients with chronic heart failure (PEECH). J Am Coll Cardiol. 2006;48(6):1198–1205. PMID 16979005

• Bonetti et al. 2003In a Mayo Clinic study of 23 patients with refractory angina, a 35-hour EECP course measurably improved endothelial function, still present one month after completion. Confirmed by a randomised, sham-controlled trial (Braith 2010) and a meta-analysis of 19 randomised trials (Yin 2023).

  Bonetti PO, Barsness GW, Keelan PC, et al. Enhanced external counterpulsation improves endothelial function in patients with symptomatic coronary artery disease. J Am Coll Cardiol. 2003;41(10):1761–1768. PMID 12767662

• Braith et al. 2010A randomised, sham-controlled trial of 42 patients with coronary artery disease showed that EECP improves flow-mediated dilation, a measure of vascular adaptability closely linked to shear stress. The growth of bypass vessels itself was not measured there; it is the physiologically plausible pathway behind it.

  Braith RW, Conti CR, Nichols WW, et al. Enhanced external counterpulsation improves peripheral artery flow-mediated dilation in patients with chronic angina: a randomized sham-controlled study. Circulation. 2010;122(16):1612–1620. PMID 20921442

• Bonetti et al. 2004A documented case from the Mayo Clinic describes a young woman with pronounced coronary endothelial dysfunction without narrowing of the large vessels, whose symptoms decreased markedly and lastingly after a 35-hour EECP course. The approach is supported by the studies on endothelial function under EECP.

  Bonetti PO, Gadasalli SN, Lerman A, Barsness GW. Successful treatment of symptomatic coronary endothelial dysfunction with enhanced external counterpulsation. Mayo Clin Proc. 2004;79(5):690–692. PMID 15132416

• Wu et al. 2023In a pilot study at the Karolinska Institute, ten patients with long-Covid angina and documented microvascular dysfunction received 15 EECP sessions. Afterwards the six-minute walking distance was about 30 metres longer, angina and fatigue had improved, as had quality of life. A small study without a control group; larger studies are pending. For long Covid and ME/CFS, EECP is therefore an individual, physiologically well-founded therapeutic trial.

  Wu E, Mahdi A, Nickander J, et al. Enhanced External Counterpulsation for Management of Postacute Sequelae of SARS-CoV-2 Associated Microvascular Angina and Fatigue: An Interventional Pilot Study. Cardiol Res Pract. 2023;2023:6687803. PMID 38179014

• Cochrane review 2010In 2010 the Cochrane review found only one randomised trial (MUST-EECP, 139 patients) and judged its methodology and conclusiveness critically: the evidence for effectiveness in chronic angina was inconclusive. Since then further randomised trials and meta-analyses have been published, and the 2024 European guideline lists EECP as an option for refractory angina. We mention the review because it belongs to an honest assessment.

  Amin F, Al Hajeri A, Civelek B, Fedorowicz Z, Manzer BM. Enhanced external counterpulsation for chronic angina pectoris. Cochrane Database Syst Rev. 2010;(2):CD007219. PMID 20166092

As of October 2026. Studies describe groups, not the individual. Whether EECP makes sense for you, we decide together.

• What does randomised mean?

  Participants are assigned by chance to the treatment or the comparison group. That way the treatment, not the selection, accounts for the difference. It is considered the most reliable form of study.

• What does placebo- or sham-controlled mean?

  The comparison group receives a sham treatment, with EECP for example cuffs at very low pressure. Nobody knows who receives the real treatment. That separates the effect from expectation.

• What is a meta-analysis?

  A summary of many individual studies on one question. The results are analysed together. That gives a more reliable picture than a single study.

• What is an observational study or a registry?

  Here treatments are documented in everyday practice, without a comparison group. A registry collects such data from many centres. That shows how many treated people fare, but can say less reliably what exactly caused the effect.