The efficacy and safety of coronary sinus reducer in refractory angina: a systematic review and meta-analysis
Abstract Background Refractory angina is a challenging medical disorder associated with continuous anginal symptoms that do not respond to medical treatments or revascularization interventions. Coronary sinus reducer (CSR) has been introduced as a promising treatment option for patients with refract...
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BMC
2025-07-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-025-04617-8 |
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| author | Ahmed Elshahat Muhammad Ashraf Husain Ahmed Elbataa Ahmed Farid Gadelmawla Hamdy A. Makhlouf Rahma AbdElfattah Ibrahim Mohammed Sabri Hassanin Fayed Mohamed Rzk Ahmed Elmorsy Mohamed Ahmed Helmi Moaz Abouelmagd Ahmed O. Sena Ahmed Bahnasy Emad Singer Ahmed Almahdy Mohamed Mohamed Yasser Elnaggar Shereen Mohamed Olama Mahmoud G. A. Saleh Esraa A. Shaban Ahmed Abdelaziz |
| author_facet | Ahmed Elshahat Muhammad Ashraf Husain Ahmed Elbataa Ahmed Farid Gadelmawla Hamdy A. Makhlouf Rahma AbdElfattah Ibrahim Mohammed Sabri Hassanin Fayed Mohamed Rzk Ahmed Elmorsy Mohamed Ahmed Helmi Moaz Abouelmagd Ahmed O. Sena Ahmed Bahnasy Emad Singer Ahmed Almahdy Mohamed Mohamed Yasser Elnaggar Shereen Mohamed Olama Mahmoud G. A. Saleh Esraa A. Shaban Ahmed Abdelaziz |
| author_sort | Ahmed Elshahat |
| collection | DOAJ |
| description | Abstract Background Refractory angina is a challenging medical disorder associated with continuous anginal symptoms that do not respond to medical treatments or revascularization interventions. Coronary sinus reducer (CSR) has been introduced as a promising treatment option for patients with refractory angina. However, the avaliable evidence regarding the exact role of CSR in managing refractory angina is still inconclusive and limited by several factors, such as small sample size studies, and short follow up periods. Therefore, we conducted this study to evaluate the effectiveness and safety of CSR for managing patients with refractory angina. Methods An extensive digital search of several databases encompassing PubMed, Scopus, Web of Science, and Cochrane Library was conducted from inception until August 2024. We included all studies that assessed the clinical and functional outcomes of CSR in treating patients with refractory angina. Our primary endpoint was ≥ 1 class improvement of the Canadian Cardiovascular Society (CCS) score. Secondary outcomes were implantation success, periprocedural complications, and cardiovascular mortality. We also assessed the functional outcomes, such as the six-minute walk distance (6MWD), CCS, and Seattle Angina Questionnaire (SAQ) scores. Results 20 studies comprising 1565 patients constituted our systematic review and meta-analysis. Our pooled analysis revealed that 70% (95% CI, [65–74%], P < 0.001) of the patients showed an improvement ≥ 1 class in CCS score after CSR. Additionally, the implantation success rate was 99% (95% CI [98–100%], P < 0.001), and the periprocedural complications were severely low and estimated at 2% with 95% CI of [1–3%]. The pooled analysis showed that CSR significantly improved the functional outcomes, including 6MWD, CCS score, and all SAQ domains. Conclusion CSR appears to be a safe and effective treatment for refractory angina, providing significant improvements in symptoms and quality of life. The significant success rate of implantation and very low complication rates support its use as an alternative therapy for patients not permitted for conventional revascularization. Clinical trial number Not applicable. |
| format | Article |
| id | doaj-art-2c0754d5e3314fd3a495c9b662e22a4b |
| institution | Kabale University |
| issn | 1471-2261 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | BMC Cardiovascular Disorders |
| spelling | doaj-art-2c0754d5e3314fd3a495c9b662e22a4b2025-08-20T03:45:44ZengBMCBMC Cardiovascular Disorders1471-22612025-07-0125112010.1186/s12872-025-04617-8The efficacy and safety of coronary sinus reducer in refractory angina: a systematic review and meta-analysisAhmed Elshahat0Muhammad Ashraf Husain1Ahmed Elbataa2Ahmed Farid Gadelmawla3Hamdy A. Makhlouf4Rahma AbdElfattah Ibrahim5Mohammed Sabri Hassanin6Fayed Mohamed Rzk7Ahmed Elmorsy Mohamed8Ahmed Helmi9Moaz Abouelmagd10Ahmed O. Sena11Ahmed Bahnasy12Emad Singer13Ahmed Almahdy Mohamed14Mohamed Yasser Elnaggar15Shereen Mohamed Olama16Mahmoud G. A. Saleh17Esraa A. Shaban18Ahmed Abdelaziz19Faculty of Medicine, Al-Azhar UniversityFaculty of Medicine, Al-Azhar UniversityFaculty of Medicine, Al-Azhar UniversityFaculty of Medicine, Menoufia UniversityMedical Research Group of Egypt, Negida AcademyFaculty of Medicine, Kafr Elsheikh UniversityFaculty of Medicine, Al-Azhar UniversityFaculty of Medicine, Menoufia UniversityFaculty of Medicine, Tanta UniversityFaculty of Medicine, Alexandria UniversityDepartment of Cardiovascular Medicine, Cairo University HospitalsDepartment of Cardiovascular Medicine, Cairo University HospitalsHematology and Oncology Department, Medicine, Mayo ClinicUniversity of Texas MD AndersonDepartment of Medicine, Cardiovascular Division, University of Minnesota Twin CitiesFaculty of Medicine, Mansoura UniversityDepartment of Internal Medicine, College of Medicine, Northern Border UniversityDepartment of Chemistry, College of Science, Northern Border UniversityFaculty of Medicine, Zagazig UniversityFaculty of Medicine, Al-Azhar UniversityAbstract Background Refractory angina is a challenging medical disorder associated with continuous anginal symptoms that do not respond to medical treatments or revascularization interventions. Coronary sinus reducer (CSR) has been introduced as a promising treatment option for patients with refractory angina. However, the avaliable evidence regarding the exact role of CSR in managing refractory angina is still inconclusive and limited by several factors, such as small sample size studies, and short follow up periods. Therefore, we conducted this study to evaluate the effectiveness and safety of CSR for managing patients with refractory angina. Methods An extensive digital search of several databases encompassing PubMed, Scopus, Web of Science, and Cochrane Library was conducted from inception until August 2024. We included all studies that assessed the clinical and functional outcomes of CSR in treating patients with refractory angina. Our primary endpoint was ≥ 1 class improvement of the Canadian Cardiovascular Society (CCS) score. Secondary outcomes were implantation success, periprocedural complications, and cardiovascular mortality. We also assessed the functional outcomes, such as the six-minute walk distance (6MWD), CCS, and Seattle Angina Questionnaire (SAQ) scores. Results 20 studies comprising 1565 patients constituted our systematic review and meta-analysis. Our pooled analysis revealed that 70% (95% CI, [65–74%], P < 0.001) of the patients showed an improvement ≥ 1 class in CCS score after CSR. Additionally, the implantation success rate was 99% (95% CI [98–100%], P < 0.001), and the periprocedural complications were severely low and estimated at 2% with 95% CI of [1–3%]. The pooled analysis showed that CSR significantly improved the functional outcomes, including 6MWD, CCS score, and all SAQ domains. Conclusion CSR appears to be a safe and effective treatment for refractory angina, providing significant improvements in symptoms and quality of life. The significant success rate of implantation and very low complication rates support its use as an alternative therapy for patients not permitted for conventional revascularization. Clinical trial number Not applicable.https://doi.org/10.1186/s12872-025-04617-8Coronary sinus reducerCSRRefractory anginaAngina pectorisStable anginaUnstable angina |
| spellingShingle | Ahmed Elshahat Muhammad Ashraf Husain Ahmed Elbataa Ahmed Farid Gadelmawla Hamdy A. Makhlouf Rahma AbdElfattah Ibrahim Mohammed Sabri Hassanin Fayed Mohamed Rzk Ahmed Elmorsy Mohamed Ahmed Helmi Moaz Abouelmagd Ahmed O. Sena Ahmed Bahnasy Emad Singer Ahmed Almahdy Mohamed Mohamed Yasser Elnaggar Shereen Mohamed Olama Mahmoud G. A. Saleh Esraa A. Shaban Ahmed Abdelaziz The efficacy and safety of coronary sinus reducer in refractory angina: a systematic review and meta-analysis BMC Cardiovascular Disorders Coronary sinus reducer CSR Refractory angina Angina pectoris Stable angina Unstable angina |
| title | The efficacy and safety of coronary sinus reducer in refractory angina: a systematic review and meta-analysis |
| title_full | The efficacy and safety of coronary sinus reducer in refractory angina: a systematic review and meta-analysis |
| title_fullStr | The efficacy and safety of coronary sinus reducer in refractory angina: a systematic review and meta-analysis |
| title_full_unstemmed | The efficacy and safety of coronary sinus reducer in refractory angina: a systematic review and meta-analysis |
| title_short | The efficacy and safety of coronary sinus reducer in refractory angina: a systematic review and meta-analysis |
| title_sort | efficacy and safety of coronary sinus reducer in refractory angina a systematic review and meta analysis |
| topic | Coronary sinus reducer CSR Refractory angina Angina pectoris Stable angina Unstable angina |
| url | https://doi.org/10.1186/s12872-025-04617-8 |
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