Tuesday, February 10, 2015

Research Highlights: New Device Implanted in Coronary Sinus May Improve Symptoms of Refractory Angina

New Device Implanted in Coronary Sinus May Improve Symptoms of Refractory Angina 

A recent study published in the New England Journal of Medicine (NEJM) has investigated the efficacy of a new device designed to relive refractory angina in patients who suffer from coronary artery disease. The device is implanted in the coronary sinus where it increases pressure to relieve pain caused by angina.
104 patients at 11 different clinical centers participated in this study. All patients were over 18 years of age and had been diagnosed with class III or IV angina that had not improved with existing therapies. Half of the participants had the device implanted while the other half had a sham device implanted and served as the control group. This study was double blind so neither participants themselves nor the researchers (with the exception of the physicians who performed the implantations) knew which participants were in which group. Over the course of 3 years, researchers monitored patient angina by measuring cardiac wall motion and by asking participants to rate their symptoms in a questionnaire.
Results showed significant improvement in at least one angina class in 71% of the treatment group compared to only 42% of the control group. 35% of treatment group participants further reported improvement in 2 or more angina classes compared to 15% of control group participants. Thus, the implantation of this device was associated with greater relief from angina-related symptoms.
As heart disease rates and life expectancies for patients with coronary heart disease rise in the Western world, rates of refractory angina rise as well. It is thus vital to develop improved therapies for the symptoms of angina, since many current treatments are not very effective. However, despite its clinical importance, this study was not without limitations. The study relied heavily on patient self-report and the number of participants was relatively small (n = 104). Further studies are needed to confirm the efficacy of the device and to understand its applications on a wider scale, but for now this coronary sinus implantation device shows promise as an effective treatment for refractory angina.

N Engl J Med. 2015; 372:519-527. doi: 10.1056/NEJMoa1402556.

Caroline Russell-Troutman is the 2014-2015 Research Highlights Editor.
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