Safety and efficacy of a device to narrow the coronary sinus for the treatment of refractory angina: A single-centre real-world experience

M Abawi, F Nijhoff, P R Stella, M Voskuil, D Benedetto, P A Doevendans, P Agostoni, M Abawi, F Nijhoff, P R Stella, M Voskuil, D Benedetto, P A Doevendans, P Agostoni

Abstract

Objective: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Coronary sinus; Reducer stent; Refractory angina; Stable angina pectoris.

Conflict of interest statement

Conflict of interestM. Abawi, F. Nijhoff, P.R. Stella, M. Voskuil, D. Benedetto, P.A. Doevendans and P. Agostoni state that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Reducer implantation in patients with (A–C) and without presence of Dual-Chamber leads (D–F). Angiogram of the coronary sinus (A and D), 9 French guiding catheter positioned deeply in the coronary sinus (B) implantation of the Reducer after retrieval of the 9 French guiding catheter to the proximal part of the coronary sinus (C and E), angiographic control of the coronary sinus after Reducer implantation (F)
Fig. 2
Fig. 2
Canadian Cardiovascular Society (CCS) class of individual patients at baseline and 9 months after Reducer implantation
Fig. 3
Fig. 3
Canadian Cardiovascular Society (CCS) functional class changes after Reducer implantation (positive numbers mean improvement). According to this figure, 17 patients improved at least 1 CCS class

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Source: PubMed

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