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The Efficacy of Coronary Sinus Reducer in Patients with Refractory Angina: A Systematic Review and Meta-Analysis
Panagiotis Theofilis1, Panayotis K Vlachakis1, Marios Sagris1
11st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, 11527 Athens, Greece.
Insights
The coronary sinus reducer (CSR) offers a promising treatment for refractory angina, demonstrating high success rates and significant symptom improvement in patients with coronary artery disease. This minimally invasive procedure effectively reduces angina severity, enhancing quality of life.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Refractory angina is a challenging condition in coronary artery disease patients.
- The coronary sinus reducer (CSR) is an emerging therapeutic option for refractory angina.
- Investigating the efficacy of CSR is crucial for improving patient outcomes.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of the coronary sinus reducer (CSR) in patients with refractory angina.
- To assess procedural success, angina symptom improvement (Canadian Cardiovascular Society class), and adverse events associated with CSR implantation.
- To provide a quantitative summary of CSR's effectiveness and safety profile.
Main Methods:
- Systematic literature review and random-effects meta-analysis.
- Inclusion of 12 studies from 515 initially identified.
- Assessment of primary endpoints: procedural success and CCS class improvement (≥1 class).
- Evaluation of secondary endpoints: periprocedural adverse events, CCS class improvement (≥2 classes), and mean CCS class change.
- Publication bias and risk of bias assessments were performed.
Main Results:
- High procedural success rate for CSR implantation (98%).
- Low rate of periprocedural complications (6%).
- Significant improvement in angina symptoms: 75% improved by at least 1 CCS class, and 39% improved by at least 2 CCS classes.
- Mean reduction in CCS class of -1.24.
Conclusions:
- The coronary sinus reducer (CSR) is associated with high implantation success rates.
- CSR significantly improves angina symptoms in patients with refractory angina.
- CSR represents a safe and effective treatment option for refractory angina.
Background:
Refractory angina is a frequently encountered phenomenon in patients with coronary artery disease, often presenting therapeutic challenges to the clinical cardiologist. Novel treatment methods have been explored in this direction, with the coronary sinus reducer (CSR) being among the most extensively-investigated.
Methods:
We conducted a systematic review of the literature for studies assessing the efficacy of CSR in patients with refractory angina. The primary endpoints of interest were procedural success and the improvement in angina according to the Canadian Cardiovascular Society (CCS) by at least one class. Secondary endpoints were the rate of periprocedural adverse events, the improvement by at least 2 CCS classes, and the mean change in CCS class. A random-effects meta-analysis of proportions (procedural success, improvement by 1 or 2 classes, periprocedural adverse events) or means (mean CCS class change) were performed. was chosen as the metric for between-study heterogeneity. Publication bias was assessed by the inspection of funnel plots and Egger's regression test. We examined the risk of bias according to the Newcastle-Ottawa Scale.
Results:
From a total of 515 studies identified from the original search, 12 studies were finally included for data extraction. Based on their meta-analysis, we observed a high CSR procedural success (98%, 95% confidence interval (CI) 96 to 99%) with a low rate of periprocedural complications (6%, 95% CI 5 to 7%), while most patients exhibited an improvement by at least 1 CCS class (75%, 95% CI 66 to 83%) after the intervention. A significant proportion of patients demonstrated an improvement by at least 2 CCS classes (39%, 95% CI 34 to 45%), with a mean change of -1.24 CCS class (95% CI -1.40 to -1.08).
Conclusions:
CSR is associated with high implantation success rates and significant improvements in angina symptoms for patients with refractory angina.
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