Coronary Sinus Reducer Device for the Treatment of Refractory Angina: a Multicenter Initial Experience

Detalhes bibliográficos
Autor(a) principal: Ferreira Reis, J
Data de Publicação: 2023
Outros Autores: Brízido, C, Madeira, S, Ramos, R, Almeida, M, Cacela, D
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10400.17/4739
Resumo: Introduction: The coronary sinus Reducer (CSR) device has emerged as a complementary therapy in patients with severe angina refractory to optimal medical therapy and not amenable to revascularization. Our aim was to assess the safety and efficacy of the CSR in a real-world setting. Methods: Twenty-six patients with refractory angina (RA) and evidence of myocardial ischemia attributable to the left coronary artery considered unsuitable for revascularization were treated with the CSR at two centers between May 2017 and July 2019. Safety endpoints were procedural success and complications. Efficacy endpoints, assessed at six-month follow-up, were reduction in CCS class, improvement in quality of life (QoL) assessed using the short version of the Seattle Angina Questionnaire (SAQ-7), and reduction in antianginal therapy. Results: Twenty-three patients had end-stage coronary artery disease without revascularization targets and three had microvascular disease without epicardial stenosis. Procedural success was achieved in 23 patients, with two device/procedure-related complications and one anatomically-related failure to deliver the device. A total of 24 patients had the device implanted and entered the efficacy analysis. Eighteen patients (75.0%) had a reduction of at least one CCS class, 41.7% had a reduction of at least two classes, and 16.7% became asymptomatic, with a mean reduction in CCS class of 1.3±0.2 (p=0.001) at six-month follow-up. All SAQ-7 domains improved, notably physical limitation (p=0.001), angina frequency (p=0.005) and QoL (p=0.006). There was a mean reduction in anti-ischemic drugs from 3.4±1.1 to 2.9±1.2 (p=0.010). Conclusion: In this real-world, multicenter experience, implantation of the CSR was associated with improvement in angina and QoL in patients with RA.
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spelling Coronary Sinus Reducer Device for the Treatment of Refractory Angina: a Multicenter Initial ExperienceDispositivo de Redução do Seio Coronário no Tratamento de Angina Refratária: uma Experiência MulticêntricaHSM CARHumansAngina Pectoris / surgeryCoronary Sinus* / surgeryProstheses and ImplantsQuality of Life*Treatment OutcomeIntroduction: The coronary sinus Reducer (CSR) device has emerged as a complementary therapy in patients with severe angina refractory to optimal medical therapy and not amenable to revascularization. Our aim was to assess the safety and efficacy of the CSR in a real-world setting. Methods: Twenty-six patients with refractory angina (RA) and evidence of myocardial ischemia attributable to the left coronary artery considered unsuitable for revascularization were treated with the CSR at two centers between May 2017 and July 2019. Safety endpoints were procedural success and complications. Efficacy endpoints, assessed at six-month follow-up, were reduction in CCS class, improvement in quality of life (QoL) assessed using the short version of the Seattle Angina Questionnaire (SAQ-7), and reduction in antianginal therapy. Results: Twenty-three patients had end-stage coronary artery disease without revascularization targets and three had microvascular disease without epicardial stenosis. Procedural success was achieved in 23 patients, with two device/procedure-related complications and one anatomically-related failure to deliver the device. A total of 24 patients had the device implanted and entered the efficacy analysis. Eighteen patients (75.0%) had a reduction of at least one CCS class, 41.7% had a reduction of at least two classes, and 16.7% became asymptomatic, with a mean reduction in CCS class of 1.3±0.2 (p=0.001) at six-month follow-up. All SAQ-7 domains improved, notably physical limitation (p=0.001), angina frequency (p=0.005) and QoL (p=0.006). There was a mean reduction in anti-ischemic drugs from 3.4±1.1 to 2.9±1.2 (p=0.010). Conclusion: In this real-world, multicenter experience, implantation of the CSR was associated with improvement in angina and QoL in patients with RA.Introdução: O dispositivo de redução do seio coronário (DRSC) constitui uma terapêutica complementar em doentes com angina refratária à terapêutica médica e não passíveis de revascularização. O objectivo era avaliar a segurança e eficácia do DRSC numa coorte do mundo real. Métodos: Vinte e seis doentes com angina refratária, evidência de isquemia miocárdica atribuível à artéria coronária esquerda e considerados inadequados para revascularização foram tratados com o DRSC em dois centros terciários portugueses entre maio de 2017 e julho de 2019. Os endpoints de segurança foram o sucesso do procedimento e complicações. Os endpoints de eficácia, avaliados aos seis meses de follow-up, foram uma redução na classe de angina da CCS, melhoria na qualidade de vida avaliada pela versão abreviada do Seattle Angina Questionnaire (SAQ-7) e redução na terapêutica antianginosa. Resultados: Vinte e três doentes tinham doença coronária sem alvos de revascularização e três, doença microvascular sem estenoses epicárdicas. O sucesso do procedimento foi alcançado em 23 doentes, com duas complicações relacionadas com dispositivo/procedimento e uma falha na entrega do dispositivo. No total, 24 doentes implantaram o dispositivo e entraram na análise de eficácia. Dezoito doentes (75,0%) sofreram uma redução de pelo menos uma classe CCS, 41,7% sofreram uma redução de pelo menos duas classes e 16,7% tornaram-se assintomáticos, com uma redução média da classe CCS de 1,3±0,2 (p=0,001), seis meses de follow-up. Verificou-se uma melhoria de todos os domínios do SAQ-7, nomeadamente limitação física (p=0,001), frequência de angina (p=0,005) e qualidade de vida (p=0,006). Verificou-se uma redução média de fármacos antianginosos de 3,4±1,1 para 2,9±1,2 (p=0,010). Conclusão: Nesta experiência multicêntrica do mundo real, a implantação do DRSC foi associada à melhoria das queixas anginosas e da qualidade de vida em doentes com angina refratária não passível de revascularização.Elsevier EspañaRepositório do Centro Hospitalar Universitário de Lisboa Central, EPEFerreira Reis, JBrízido, CMadeira, SRamos, RAlmeida, MCacela, D2023-11-07T12:25:58Z2023-052023-05-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/4739engRev Port Cardiol . 2023 May;42(5):413-420.10.1016/j.repc.2022.05.010info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-11-12T06:10:58Zoai:repositorio.chlc.min-saude.pt:10400.17/4739Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T22:38:03.361711Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Coronary Sinus Reducer Device for the Treatment of Refractory Angina: a Multicenter Initial Experience
Dispositivo de Redução do Seio Coronário no Tratamento de Angina Refratária: uma Experiência Multicêntrica
title Coronary Sinus Reducer Device for the Treatment of Refractory Angina: a Multicenter Initial Experience
spellingShingle Coronary Sinus Reducer Device for the Treatment of Refractory Angina: a Multicenter Initial Experience
Ferreira Reis, J
HSM CAR
Humans
Angina Pectoris / surgery
Coronary Sinus* / surgery
Prostheses and Implants
Quality of Life*
Treatment Outcome
title_short Coronary Sinus Reducer Device for the Treatment of Refractory Angina: a Multicenter Initial Experience
title_full Coronary Sinus Reducer Device for the Treatment of Refractory Angina: a Multicenter Initial Experience
title_fullStr Coronary Sinus Reducer Device for the Treatment of Refractory Angina: a Multicenter Initial Experience
title_full_unstemmed Coronary Sinus Reducer Device for the Treatment of Refractory Angina: a Multicenter Initial Experience
title_sort Coronary Sinus Reducer Device for the Treatment of Refractory Angina: a Multicenter Initial Experience
author Ferreira Reis, J
author_facet Ferreira Reis, J
Brízido, C
Madeira, S
Ramos, R
Almeida, M
Cacela, D
author_role author
author2 Brízido, C
Madeira, S
Ramos, R
Almeida, M
Cacela, D
author2_role author
author
author
author
author
dc.contributor.none.fl_str_mv Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE
dc.contributor.author.fl_str_mv Ferreira Reis, J
Brízido, C
Madeira, S
Ramos, R
Almeida, M
Cacela, D
dc.subject.por.fl_str_mv HSM CAR
Humans
Angina Pectoris / surgery
Coronary Sinus* / surgery
Prostheses and Implants
Quality of Life*
Treatment Outcome
topic HSM CAR
Humans
Angina Pectoris / surgery
Coronary Sinus* / surgery
Prostheses and Implants
Quality of Life*
Treatment Outcome
description Introduction: The coronary sinus Reducer (CSR) device has emerged as a complementary therapy in patients with severe angina refractory to optimal medical therapy and not amenable to revascularization. Our aim was to assess the safety and efficacy of the CSR in a real-world setting. Methods: Twenty-six patients with refractory angina (RA) and evidence of myocardial ischemia attributable to the left coronary artery considered unsuitable for revascularization were treated with the CSR at two centers between May 2017 and July 2019. Safety endpoints were procedural success and complications. Efficacy endpoints, assessed at six-month follow-up, were reduction in CCS class, improvement in quality of life (QoL) assessed using the short version of the Seattle Angina Questionnaire (SAQ-7), and reduction in antianginal therapy. Results: Twenty-three patients had end-stage coronary artery disease without revascularization targets and three had microvascular disease without epicardial stenosis. Procedural success was achieved in 23 patients, with two device/procedure-related complications and one anatomically-related failure to deliver the device. A total of 24 patients had the device implanted and entered the efficacy analysis. Eighteen patients (75.0%) had a reduction of at least one CCS class, 41.7% had a reduction of at least two classes, and 16.7% became asymptomatic, with a mean reduction in CCS class of 1.3±0.2 (p=0.001) at six-month follow-up. All SAQ-7 domains improved, notably physical limitation (p=0.001), angina frequency (p=0.005) and QoL (p=0.006). There was a mean reduction in anti-ischemic drugs from 3.4±1.1 to 2.9±1.2 (p=0.010). Conclusion: In this real-world, multicenter experience, implantation of the CSR was associated with improvement in angina and QoL in patients with RA.
publishDate 2023
dc.date.none.fl_str_mv 2023-11-07T12:25:58Z
2023-05
2023-05-01T00:00:00Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10400.17/4739
url http://hdl.handle.net/10400.17/4739
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Rev Port Cardiol . 2023 May;42(5):413-420.
10.1016/j.repc.2022.05.010
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier España
publisher.none.fl_str_mv Elsevier España
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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