Francesco Ponticelli1, Arif A Khokhar1, Geert Leenders2, Maayan Konigstein3, Carlo Zivelonghi4, Pierfrancesco Agostoni4, Jan-Peter van Kuijk5, Issameddine Ajmi6, Steven Lindsay7, Matjaž Bunc8, Matteo Tebaldi9, Alessandro Cafaro10, Kevin Cheng11, Alfonso Ielasi12, Tiffany Patterson13, Jan Sebastian Wolter14, Fabio Sgura15, Federico De Marco16, Dan Ioanes17, Gianpiero D'Amico18, Marco Ciardetti19, Sergio Berti19, Stefano Guarracini20, Michele Di Mauro20, Guglielmo Gallone21, Mirthe Dekker2, Max J M Silvis2, Giuseppe Tarantini18, Simon Redwood13, Antonio Colombo1, Christoph Liebetrau22, Ranil de Silva23, Claudio Rapezzi24, Roberto Ferrari24, Gianluca Campo9, Steffen Schnupp6, Leo Timmers5, Stefan Verheye4, Pieter Stella2, Shmuel Banai3, Francesco Giannini25. 1. Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy. 2. Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands. 3. Division of Cardiology, Tel Aviv Sourasky Medical Center, and the Sackler Faculty of Medicine, Tel-Aviv, Israel. 4. Antwerp Cardiovascular Center, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium. 5. Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, the Netherlands. 6. Department of Cardiology, Angiology and Pulmonology, Coburg Hospital, Coburg, Germany. 7. Department of Cardiology, Bradford Royal Infirmary, Bradford, United Kingdom. 8. Department of Cardiology, University Medical Centre, Ljubljana, Slovenia. 9. Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy. 10. Department of Cardiology, General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy. 11. National Heart and Lung Institute, Imperial College London, London, United Kingdom. 12. U.O. di Cardiologia Clinica ed Interventistica, Istituto Clinico Sant'Ambrogio, Milan, Italy. 13. Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. 14. Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site Rhine-Main, Frankfurt am Main, Germany. 15. Institute of Cardiology, Policlinico Hospital, University of Modena and Reggio Emilia, Italy. 16. Department of Cardiology, IRCCS Policlinico S. Donato, San Donato Milanese, Italy. 17. Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. 18. Department of Cardiology Thoracic and Vascular Sciences and Public Health, University of Padua, Italy. 19. Fondazione Toscana G. Monasterio - Ospedale del Cuore G. Pasquinucci, Massa, Italy. 20. Cardiovascular Department, Casa di cura Pierangeli, Pescara, Italy. 21. Department of Cardiology, University of Turin, Turin, Italy. 22. Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany. 23. National Heart and Lung Institute, Imperial College London, London, United Kingdom; Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom. 24. Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy; Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy. 25. Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy. Electronic address: giannini_fra@yahoo.it.
Abstract
INTRODUCTION: Refractory angina (RA) is considered the end-stage of coronary artery disease, and often has no interventional treatment options. Coronary sinus Reducer (CSR) is a recent addition to the therapeutic arsenal, but its efficacy has only been evaluated on small populations. The RESOURCE registry provides further insights into this therapy. METHODS: The RESOURCE is an observational, retrospective registry that includes 658 patients with RA from 20 centers in Europe, United Kingdom and Israel. Prespecified endpoints were the amelioration of anginal symptoms evaluated with the Canadian Cardiovascular Society (CCS) score, the rates of procedural success and complications, and MACEs as composite of all-cause mortality, acute coronary syndromes, and stroke. RESULTS: At a median follow-up of 502 days (IQR 225-1091) after CSR implantation, 39.7% of patients improved by ≥2 CCS classes (primary endpoint), and 76% by ≥1 class. Procedural success was achieved in 96.7% of attempts, with 3% of procedures aborted mostly for unsuitable coronary sinus anatomy. Any complication occurred in 5.7% of procedures, but never required bailout surgery nor resulted in intra- or periprocedural death or myocardial infarction. One patient developed periprocedural stroke after inadvertent carotid artery puncture. At the last available follow-up, overall mortality and MACE were 10.4% and 14.6% respectively. At one, three and five years, mortality rate at Kaplan-Meier analysis was 4%, 13.7%, and 23.4% respectively. CONCLUSIONS: CSR implantation is safe and reduces angina in patients with refractory angina.
INTRODUCTION:Refractory angina (RA) is considered the end-stage of coronary artery disease, and often has no interventional treatment options. Coronary sinus Reducer (CSR) is a recent addition to the therapeutic arsenal, but its efficacy has only been evaluated on small populations. The RESOURCE registry provides further insights into this therapy. METHODS: The RESOURCE is an observational, retrospective registry that includes 658 patients with RA from 20 centers in Europe, United Kingdom and Israel. Prespecified endpoints were the amelioration of anginal symptoms evaluated with the Canadian Cardiovascular Society (CCS) score, the rates of procedural success and complications, and MACEs as composite of all-cause mortality, acute coronary syndromes, and stroke. RESULTS: At a median follow-up of 502 days (IQR 225-1091) after CSR implantation, 39.7% of patients improved by ≥2 CCS classes (primary endpoint), and 76% by ≥1 class. Procedural success was achieved in 96.7% of attempts, with 3% of procedures aborted mostly for unsuitable coronary sinus anatomy. Any complication occurred in 5.7% of procedures, but never required bailout surgery nor resulted in intra- or periprocedural death or myocardial infarction. One patient developed periprocedural stroke after inadvertent carotid artery puncture. At the last available follow-up, overall mortality and MACE were 10.4% and 14.6% respectively. At one, three and five years, mortality rate at Kaplan-Meier analysis was 4%, 13.7%, and 23.4% respectively. CONCLUSIONS: CSR implantation is safe and reduces angina in patients with refractory angina.