New Reducer implant controls severe angina symptoms even in refractory angina

The coronary sinus (CS) Reducer is a novel device designed to aid in the management and to improve quality of life of patients with severe angina symptoms refractory to optimal medical and interventional therapies. A new study published in the International Journal of Cardiology confirms its safety and efficacy in a real-world multi-center experience for reducing angina symptoms and improving quality of life.

Francesco Giannini, Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy, and colleagues to assess the safety and efficacy of the Reducer in a real-world cohort of patients presenting with refractory angina.

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For the study, one hundred forty-one consecutive patients were treated with CS Reducer implantation. The primary efficacy endpoint was a reduction in angina symptoms from baseline as assessed by Canadian Cardiovascular Society (CCS) class status and Seattle Angina Questionnaire (SAQ) scores. The primary safety endpoint was successful Reducer device delivery and deployment in the absence of any device-related events.

Procedural success was achieved in 139 (98.6%) patients. Reducer implantation was not obtained in 2 (1.4%) patients because of the unfavorable anatomy of the CS. There were no CS perforations, cardiac tamponade, peri-procedural death or myocardial infarction during a median follow-up of 14 months (range from 6- to 70-month). In patients undergoing Reducer implantation, mean CCS class improved from 3.05 ± 0.53 at baseline to 1.63 ± 0.98 at follow-up. Overall, 113 (81%) patients experienced at least 1 CCS improvement, and 63 (45%) patients at least 2 CCS-class improvement. All SAQ items improved significantly (p < 0.001 for all) and translated into a significant reduction in the mean number of anti-ischemic drugs prescribed (2.37 ± 0.97 vs 2.17 ± 0.95).

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Important takeaways from the study:

• Reducer is safe with no serious adverse events related to the procedure or device.


• Reducer is associated with symptomatic benefit in refractory angina patients.


• Reducer is associated with life-quality improvement in refractory angina patients.


• Reducer implant may reduce ischemic burden in refractory angina patients.