Key result
Coronary sinus reducer implantation reduces moderate to severe ischemia by ~28 percentage points.
Why the study?
Although symptomatic benefits of the coronary sinus reducer for refractory angina are well documented, its effect on objective measures of inducible myocardial ischemia on functional stress testing remained unclear.
Does coronary sinus reducer implantation reduce inducible myocardial ischemia assessed by functional stress testing in patients with refractory angina due to obstructive coronary artery disease?
Cohort (n=153)
Does coronary sinus reducer implantation reduce inducible myocardial ischemia assessed by functional stress testing in patients with refractory angina due to obstructive coronary artery disease?
Coronary sinus reducer implantation in patients with refractory angina is associated with significant improvements in objective functional imaging markers of inducible myocardial ischemia alongside symptomatic relief.
Answers are grounded in this paper and cite their sources.
Supports ischemia reduction on SPECT in refractory angina; extends symptomatic data but leaves open randomized confirmation.
BACKGROUND: The coronary sinus reducer is an established therapy for patients with refractory angina due to obstructive coronary artery disease who are not candidates for further revascularization. Although symptomatic benefits are well documented, its effect on objective measures of ischemia remains unclear. This study aimed to evaluate the association between coronary sinus reducer implantation and inducible myocardial ischemia assessed by functional stress testing. METHODS: We retrospectively analyzed a prospectively maintained registry of consecutive patients undergoing coronary sinus reducer implantation between 2011 and 2024. Baseline assessment included Canadian Cardiovascular Society angina class, 6-minute walk test, stress echocardiography, and dipyridamole single-photon emission computed tomography imaging, repeated at 6 months. Coprimary outcomes were changes in stress wall motion score index and in the proportion of patients with moderate or severe ischemia on single-photon emission computed tomography. Clinical nonresponders were defined as no improvement in Canadian Cardiovascular Society class at 12 months. RESULTS: Among 153 treated patients, 118 had complete imaging data. Median stress wall motion score index improved from 1.38 to 1.23 ( P <0.001), and stress left ventricular ejection fraction increased from 55% to 60% ( P =0.019). The proportion of patients with moderate or severe ischemia on single-photon emission computed tomography decreased from 52% to 24% ( P <0.001). The summed difference score, available in 45 patients, did not change significantly. Clinically, 86% improved by ≥1 Canadian Cardiovascular Society class at 6 months. CONCLUSIONS: Coronary sinus reducer implantation was associated with reduced inducible ischemia on stress echocardiography and with clinical improvement. The proportion of patients with moderate or severe ischemia on single-photon emission computed tomography decreased following Reducer implantation.
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Gefen et al. (2026) conducted a cohort in Refractory angina due to obstructive coronary artery disease not suitable for further revascularization (n=153). Coronary sinus reducer implantation was evaluated on Coprimary outcomes: changes in stress wall motion score index and proportion of patients with moderate or severe ischemia on single-photon emission computed tomography at 6 months (p=<0.001). Coronary sinus reducer implantation reduced moderate/severe SPECT ischemia from 52% to 24% and improved median stress wall motion score index from 1.38 to 1.23.
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