The coronary sinus Reducer is a recently introduced device to treat patients with severe angina symptoms refractory to optimal medical therapy and not amenable for conventional revascularisation. We aimed to assess the safety and efficacy of the Reducer in a real-world cohort of patients with refractory angina.
This is a single-centre retrospective registry. Patients with severe angina symptoms, objective evidence of myocardial ischaemia using any adequate non-invasive modality and without options for conventional revascularisation were regarded eligible for Reducer implantation.
Twenty-three patients (74 % male, mean age 70 ± 8 years, 91.3 % previous bypass surgery, 82.6 % previous percutaneous intervention, 47.8 % previous myocardial infarction, 52.2 % diabetes mellitus) underwent Reducer implantation. The safety endpoint (successful implantation of the first device without device-related adverse events) was met in all patients. After a median follow-up of 9 (8–14) months the efficacy (any reduction in Canadian Cardiovascular Society (CCS) class and revascularisation-free survival) was reached in 17 patients (74 %): 8 patients (34.8 %) improved by 1 CCS class, 7 (30.4 %) by 2 CCS classes and 2 (8.7 %) by 3 CCS classes. One patient died 4 months after implantation because of progressive heart failure (not associated with Reducer implantation).
In this single-centre real-world experience, Reducer implantation was safe and demonstrated excellent clinical efficacy in the treatment of refractory angina at mid-term follow-up.
Williams B, Menon M, Satran D, et al. Patients with coronary artery disease not amenable to traditional revascularization: prevalence and 3‑year mortality. Catheter Cardiovasc Interv. 2010;75:886–91. PubMed
Chow CM, Donovan L, Johansen H. Regional variation in self-reported heart disease prevalence in Canada. Can J Cardiol. 2005;21:1265–71. PubMed
McGillion M, Arthur HM, Cook A, et al. Management of patients with refractory angina: Canadian Cardiovascular Society/Canadian Pain Society joint guidelines. Can J Cardiol. 2012;28(2 Suppl):20–41. CrossRef
Weisz G, Généreux P, Iñiguez A, et al. Ranolazine in patients with incomplete revascularisation after percutaneous coronary intervention (RIVER-PCI): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2016;387:9–15. CrossRef
Sato M, Saito T, Mitsugi M, et al. Effects of cardiac contraction and coronary sinus pressure elevation on collateral circulation. Am J Physiol. 1996;271(4 Pt 2):H1433–H1440. PubMed
Ido A, Hasebe N, Matsuhashi H, Kikuchi K. Coronary sinus occlusion enhances coronary collateral flow and reduces subendocardial ischemia. Am J Physiol Heart Circ Physiol. 2001;280:H1361–H1367. PubMed
Banai S, Schwartz M, Sievert H, et al. Long term follow-up to evaluate the safety of the neovasc reducer A device-based therapy for chronic refractory angina. annual scientific session of the american college of cardiology. J Am Coll Cardiol. 2010;(A98):E927–A980. doi: 10.1016/S0735-1097(10)60928-X.
- Safety and efficacy of a device to narrow the coronary sinus for the treatment of refractory angina: A single-centre real-world experience
- Bohn Stafleu van Loghum
Neu im Fachgebiet Kardiologie
Mail Icon II