open access

Online first
Original article
Published online: 2021-10-12
Get Citation

Efficacy of coronary sinus reducer implantation in patients with chronic total occlusion of the right coronary artery

Miha Mrak12, Nejc Pavšič12, Francesco Ponticelli34, Alessandro Beneduce4, Anna Palmisano5, Stefano Guarracini6, Antonio Esposito4, Shmuel Banai7, David Žižek12, Francesco Giannini3, Matjaž Bunc12
DOI: 10.33963/KP.a2021.0132
·
Pubmed: 34643262
Affiliations
  1. Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
  2. Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
  3. Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy
  4. Interventional Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
  5. Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
  6. Department of Cardiology, Pierangeli Clinic, Pescara, Italy
  7. Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

open access

Online first
Original article
Published online: 2021-10-12

Abstract

Background: Clinical efficacy of coronary sinus reducer (CSR) in refractory angina (RA) patients with ischemia due to the chronic total occlusion (CTO) of the right coronary artery (RCA) remains unknown.
Aims: To evaluate the efficacy of CSR implantation in RA patients with CTO RCA and compare them to CSR recipients with left coronary artery (LCA) ischemia.
Methods: Consecutive patients with CTO RCA from 2 centres were prospectively included and compared to patients with LCA ischemia. All patients underwent evaluation of angina severity and quality of life (QOL) at baseline and after 12 months. In a subgroup of CTO RCA patients stress cardiac magnetic resonance (CMR) imaging was also performed.
Results: Twenty-two patients with CTO RCA and predominant inferior and/or inferoseptal wall ischemia (CTO RCA group) were compared to 24 patients with predominant anterior, lateral and/or anteroseptal wall ischemia (LCA group). While Canadian Cardiovascular Society (CCS) angina score mean (SD) improved in CTO RCA group from 2.73 (0.46) to 1.82 (0.73) (P < 0.001) and in LCA group from 2.67 (0.57) to 1.92 (0.72) (P < 0.001), there was no intergroup difference (P = 0.350). Significant improvement in all Seattle Angina Questionnaire domains was observed. Stress CMR did not show significant reduction of ischemic inferior and/or inferoseptal segments, however improvements in transmurality index (P = 0.03) and myocardial perfusion reserve index in segments with inducible ischemia (P = 0.03) were observed in CTO RCA group.
Conclusions: In CTO RCA patients CSR implantation alleviated angina symptoms and improved QOL. Extent of improvement was comparable to that observed in patients with LCA ischemia.

Abstract

Background: Clinical efficacy of coronary sinus reducer (CSR) in refractory angina (RA) patients with ischemia due to the chronic total occlusion (CTO) of the right coronary artery (RCA) remains unknown.
Aims: To evaluate the efficacy of CSR implantation in RA patients with CTO RCA and compare them to CSR recipients with left coronary artery (LCA) ischemia.
Methods: Consecutive patients with CTO RCA from 2 centres were prospectively included and compared to patients with LCA ischemia. All patients underwent evaluation of angina severity and quality of life (QOL) at baseline and after 12 months. In a subgroup of CTO RCA patients stress cardiac magnetic resonance (CMR) imaging was also performed.
Results: Twenty-two patients with CTO RCA and predominant inferior and/or inferoseptal wall ischemia (CTO RCA group) were compared to 24 patients with predominant anterior, lateral and/or anteroseptal wall ischemia (LCA group). While Canadian Cardiovascular Society (CCS) angina score mean (SD) improved in CTO RCA group from 2.73 (0.46) to 1.82 (0.73) (P < 0.001) and in LCA group from 2.67 (0.57) to 1.92 (0.72) (P < 0.001), there was no intergroup difference (P = 0.350). Significant improvement in all Seattle Angina Questionnaire domains was observed. Stress CMR did not show significant reduction of ischemic inferior and/or inferoseptal segments, however improvements in transmurality index (P = 0.03) and myocardial perfusion reserve index in segments with inducible ischemia (P = 0.03) were observed in CTO RCA group.
Conclusions: In CTO RCA patients CSR implantation alleviated angina symptoms and improved QOL. Extent of improvement was comparable to that observed in patients with LCA ischemia.

Get Citation

Keywords

chronic total occlusion, coronary sinus reducer, refractory angina pectoris, quality of life

About this article
Title

Efficacy of coronary sinus reducer implantation in patients with chronic total occlusion of the right coronary artery

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2021-10-12

DOI

10.33963/KP.a2021.0132

Pubmed

34643262

Keywords

chronic total occlusion
coronary sinus reducer
refractory angina pectoris
quality of life

Authors

Miha Mrak
Nejc Pavšič
Francesco Ponticelli
Alessandro Beneduce
Anna Palmisano
Stefano Guarracini
Antonio Esposito
Shmuel Banai
David Žižek
Francesco Giannini
Matjaž Bunc

References (19)
  1. Parikh P, Bhatt P, Shah D, et al. First-in-Human use of coronary sinus reducer in patients with refractory angina. J Am Coll Cardiol. 2018; 72(24): 3227–3228.
  2. Verheye S, Jolicœur EM, Behan MW, et al. Efficacy of a device to narrow the coronary sinus in refractory angina. N Engl J Med. 2015; 372(6): 519–527.
  3. Giannini F, Baldetti L, Konigstein M, et al. Safety and efficacy of the reducer: a multi-center clinical registry — REDUCE study. Int J Cardiol. 2018; 269: 40–44.
  4. Giannini F, Baldetti L, Ielasi A, et al. First experience with the coronary sinus reducer system for the management of refractory angina in patients without obstructive coronary artery disease. JACC Cardiovasc Interv. 2017; 10(18): 1901–1903.
  5. Zimoch W, Kuliczkowski W, Reczuch K. Coronary sinus reducer implantation in patients with refractory angina: first experience in Poland. Kardiol Pol. 2021; 79(4): 471–472.
  6. Ponticelli F, Khokhar AA, Leenders G, et al. Safety and efficacy of coronary sinus narrowing in chronic refractory angina: Insights from the RESOURCE study. Int J Cardiol. 2021; 337: 29–37.
  7. Konigstein M, Giannini F, Banai S. The Reducer device in patients with angina pectoris: mechanisms, indications, and perspectives. Eur Heart J. 2018; 39(11): 925–933.
  8. McEntegart MB, Badar AA, Ahmad FA, et al. The collateral circulation of coronary chronic total occlusions. EuroIntervention. 2016; 11(14): e1596–e1603.
  9. Giannini F, Palmisano A, Baldetti L, et al. Patterns of regional myocardial perfusion following coronary sinus reducer implantation: insights by stress cardiac magnetic resonance. Circ Cardiovasc Imaging. 2019; 12(9): e009148.
  10. Ido A, Hasebe N, Matsuhashi H, et al. Coronary sinus occlusion enhances coronary collateral flow and reduces subendocardial ischemia. Am J Physiol Heart Circ Physiol. 2001; 280(3): H1361–H1367.
  11. 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.
  12. Giannini F, Tzanis G, Ponticelli F, et al. Technical aspects in coronary sinus Reducer implantation. EuroIntervention. 2020; 15(14): 1269–1277.
  13. Hussain ST, Paul M, Plein S, et al. Design and rationale of the MR-INFORM study: stress perfusion cardiovascular magnetic resonance imaging to guide the management of patients with stable coronary artery disease. J Cardiovasc Magn Reson. 2012; 14: 65.
  14. Schulz-Menger J, Bluemke DA, Bremerich J, et al. Standardized image interpretation and post processing in cardiovascular magnetic resonance: Society for Cardiovascular Magnetic Resonance (SCMR) board of trustees task force on standardized post processing. J Cardiovasc Magn Reson. 2013; 15(1): 35.
  15. Konigstein M, Bazan S, Revivo M, et al. Coronary Sinus Reducer implantation improves symptoms, ischaemia and physical capacity in patients with refractory angina unsuitable for myocardial revascularisation: a single-centre experience. EuroIntervention. 2018; 14(4): e452–e458.
  16. Zivelonghi C, Verheye S, Timmers L, et al. Efficacy of coronary sinus reducer in patients with non-revascularized chronic total occlusions. Am J Cardiol. 2020; 126: 1–7.
  17. Marzilli M, Crea F, Morrone D, et al. Myocardial ischemia: from disease to syndrome. Int J Cardiol. 2020; 314: 32–35.
  18. Stoller M, Traupe T, Khattab AA, et al. Effects of coronary sinus occlusion on myocardial ischaemia in humans: role of coronary collateral function. Heart. 2013; 99(8): 548–555.
  19. Leon MB, Kornowski R, Downey WE, et al. A blinded, randomized, placebo-controlled trial of percutaneous laser myocardial revascularization to improve angina symptoms in patients with severe coronary disease. J Am Coll Cardiol. 2005; 46(10): 1812–1819.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Sp. z o.o. VM Group Sp.k., ul. Świętokrzyska 73 , 80–180 Gdańsk, Poland

phone:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl