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Effect of Coronary Sinus Reducer Implantation on Aerobic Exercise Capacity in Refractory Angina Patients-A CROSSROAD
Miha Mrak1,2, Nejc Pavšič1,2, David Žižek1,2
1Department of Cardiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia.
Insights
Coronary sinus reducer (CSR) implantation improved maximal oxygen consumption in patients with refractory angina. This randomized trial suggests CSR enhances exercise capacity beyond optimal medical therapy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Research
Background:
- Refractory angina pectoris significantly impacts patients' quality of life.
- Current treatment options, including optimal medical therapy, may not fully alleviate symptoms.
- The efficacy of coronary sinus reducer (CSR) implantation on exercise capacity in a randomized setting remains unproven.
Purpose of the Study:
- To evaluate the effect of CSR implantation on maximal oxygen consumption in patients with refractory angina.
- To compare the impact of CSR implantation versus a sham procedure on exercise capacity and angina symptoms.
- To provide evidence from a randomized trial regarding CSR's influence on physiological parameters.
Main Methods:
- A randomized controlled trial involving 25 patients with Canadian Cardiovascular Society (CCS) class II-IV refractory angina pectoris.
- Patients were randomized to either CSR implantation (n=13) or a sham procedure (n=12).
- Symptom-limited cardiopulmonary exercise testing and angina assessment (CCS scale, Seattle angina pectoris questionnaire) were performed at baseline and 6-month follow-up.
Main Results:
- Maximal oxygen consumption significantly increased in the CSR group (15.56 to 18.4 mL/kg/min, p=0.03) but not in the sham group (p=0.53).
- Intergroup comparison showed a significant difference in the improvement of maximal oxygen consumption (p=0.03).
- No significant differences were observed between groups in the improvement of CCS class or SAQ domains.
Conclusions:
- Coronary sinus reducer implantation may enhance maximal oxygen consumption in patients with refractory angina pectoris, even with optimized medical therapy.
- While CSR improved a key measure of exercise capacity, its effect on subjective angina scores requires further investigation.
- This randomized trial provides evidence supporting CSR implantation as a potential therapeutic option for improving exercise tolerance in select angina patients.
Abstract:
Coronary sinus reducer (CSR) implantation is a new treatment option for patients with refractory angina pectoris. However, there is no evidence from a randomized trial that would show an improvement in exercise capacity after this treatment. The aim of this study was to evaluate the influence of CSR treatment on maximal oxygen consumption and compare it to a sham procedure. Twenty-five patients with refractory angina pectoris (Canadian Cardiovascular Society (CCS) class II-IV) were randomized to a CSR implantation (n = 13) or a sham procedure (n = 12). At baseline and after 6 months of follow-up, the patients underwent symptom-limited cardiopulmonary exercise testing with an adjusted ramp protocol and assessment of angina pectoris using the CCS scale and Seattle angina pectoris questionnaire (SAQ). In the CSR group, maximal oxygen consumption increased from 15.56 ± 4.05 to 18.4 ± 5.2 mL/kg/min (p = 0.03) but did not change in the sham group (p = 0.53); p for intergroup comparison was 0.03. In contrast, there was no difference in the improvement of the CCS class or SAQ domains. To conclude, in patients with refractory angina and optimized medical therapy, CSR implantation may improve oxygen consumption beyond that of optimal medical therapy.
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