{
  "abstract": "Background Coronary sinus reducer (CSR) implantation is the only guideline-recommended percutaneous treatment for patients with refractory angina. Data from its real-world large-scale adoption are scarce.Methods This was a national audit of CSR implanting centres in the UK between November 2014 and 2024. Centres provided data on all patients undergoing clinical CSR implantation through a structured collection template. Data collected included demographics, medical history, medications, angina status, ischaemia testing, procedural characteristics and periprocedural complications. Prespecified endpoints were appropriate patient selection, procedural success and safety, and efficacy of CSR implantation.Results 19 centres were included capturing 491 patients. Most were male (79%) with high rates of previous myocardial infarction (75%), percutaneous coronary intervention (78%) and coronary artery bypass grafting (69%). Diabetes mellitus (53%), hypertension (76%) and hypercholesterolaemia (78%) were prevalent. 74% had a preserved left ventricular ejection fraction (LVEF≥50%). Patients were severely symptomatic with 84% suffering from Canadian Cardiovascular Society (CCS) class ≥3 angina despite multiple antianginal medications (≥2 drugs 94%; ≥3 drugs 74%). Baseline ischaemia testing was common (79%). Successful CSR implantation was achieved in 95% of cases. 46 periprocedural adverse events (AEs) in 41 patients occurred (9.2%) most commonly due to access complications. Rates of major adverse cardiovascular events and severe AEs were low (<1%). 98% of patients stayed ≤1 night postprocedurally. Significant reductions in CCS class were observed at 6-month follow-up: 75% experienced ≥1 CCS class and 36% ≥2 CCS class angina reduction. Improved angina status was also observed after stratification by age, sex and diabetes mellitus.Conclusions This national audit of real-world UK practice confirms CSR implantation is being performed appropriately and safely leading to symptom improvement for patients with refractory angina. Contemporary practice aligns with the recommendations of current guidelines supporting the continued use of CSR in UK clinical practice. Prospective data collection within a national registry is warranted.",
  "authors": [
    {
      "affiliations": [
        "National Heart and Lung Institute (NHLI), Imperial College London, London, UK",
        "Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK"
      ],
      "name": "Kevin Cheng"
    },
    {
      "affiliations": [
        "Dorset County Hospital NHS Foundation Trust, Dorchester, UK"
      ],
      "name": "Fraser Witherow"
    },
    {
      "affiliations": [
        "King’s College Hospital, London, UK"
      ],
      "name": "Jonathan Byrne"
    },
    {
      "affiliations": [
        "Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK"
      ],
      "name": "Steven Lindsay"
    },
    {
      "affiliations": [
        "St Thomas’ Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK",
        "Cardiovascular Department, Faculty of Life Sciences and Medicine, King’s College London, London, UK"
      ],
      "name": "Tiffany Patterson"
    },
    {
      "affiliations": [
        "St Thomas’ Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK",
        "Cardiovascular Department, Faculty of Life Sciences and Medicine, King’s College London, London, UK"
      ],
      "name": "Kalpa De Silva"
    },
    {
      "affiliations": [
        "Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK",
        "Department of Cardiovascular Medicine, University of Cambridge, Cambridge, UK"
      ],
      "name": "Stephen P Hoole"
    },
    {
      "affiliations": [
        "Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK",
        "Acute Multidisciplinary Imaging and Interventional Centre, University of Oxford, Oxford, UK"
      ],
      "name": "Giovanni Luigi De Maria"
    },
    {
      "affiliations": [
        "St George’s University Hospitals NHS Foundation Trust, London, UK",
        "St George’s University of London, London, UK"
      ],
      "name": "James C Spratt"
    },
    {
      "affiliations": [
        "Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK",
        "Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK"
      ],
      "name": "Joel Giblett"
    },
    {
      "affiliations": [
        "Kettering General Hospital NHS Foundation Trust, Kettering, UK"
      ],
      "name": "Prashanth Raju"
    },
    {
      "affiliations": [
        "Salisbury District Hospital, Salisbury NHS Foundation Trust, Salisbury, UK"
      ],
      "name": "Tim Wells"
    },
    {
      "affiliations": [
        "Trent Cardiac Centre, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK"
      ],
      "name": "Andrew Vanezis"
    },
    {
      "affiliations": [
        "Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Ioannis Felekos"
    },
    {
      "affiliations": [
        "Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Mark Mariathas"
    },
    {
      "affiliations": [
        "Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK",
        "Anglia Ruskin School of Medicine and MTRC, Chelmsford, UK"
      ],
      "name": "Thomas R Keeble"
    },
    {
      "affiliations": [
        "Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK",
        "Anglia Ruskin School of Medicine and MTRC, Chelmsford, UK"
      ],
      "name": "John R Davies"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute (NHLI), Imperial College London, London, UK",
        "Imperial College Healthcare NHS Trust, London, UK"
      ],
      "name": "Rasha K Al-Lamee"
    },
    {
      "affiliations": [
        "Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK",
        "Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK"
      ],
      "name": "Bhavik Modi"
    },
    {
      "affiliations": [
        "Edinburgh Heart Centre, Edinburgh Royal Infirmary, Edinburgh, UK"
      ],
      "name": "Miles Behan"
    },
    {
      "affiliations": [
        "Queen Elizabeth Hospital Birmingham, Birmingham, UK"
      ],
      "name": "Alex Zaphiriou"
    },
    {
      "affiliations": [
        "Dorset Heart Centre, Royal Bournemouth Hospital, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK"
      ],
      "name": "Peter O’Kane"
    },
    {
      "affiliations": [
        "Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK"
      ],
      "name": "Jonathan M Hill"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute (NHLI), Imperial College London, London, UK",
        "Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK"
      ],
      "name": "Ranil de Silva"
    },
    {
      "affiliations": [],
      "name": "UK Coronary Sinus Reducer Audit Group Collaborators"
    }
  ],
  "title": "Coronary sinus reducer implantation for refractory angina: a national audit of UK practice",
  "uid": "1f0ca7e3-4e2d-5a22-8b48-10d6e301f2d5"
}