CoROnary SinuS Reducer implantatiOn for ischemiA reDuction

NCT ID: NCT04121845

Last Updated: 2022-07-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

25 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-01-01

Study Completion Date

2022-06-30

Brief Summary

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Patients with refractory angina pectoris have low quality of life and reduced exertional capacity. Studies have shown that the coronary sinus reducer (CSR) implantation improves the quality of life. However, to date there are no firm objective data on improvement of exertional capacity. Studies have shown a large influence of placebo effect after interventional procedures, which is even more pronounced than in medically treated patients. As angina pectoris presents entirely subjective perception of chest discomfort, its improvement may be influenced by this effect in up to 30 %. The investigators will study weather the CSR implantation improves aerobic exertional capacity in comparison to optimal medical therapy alone. Further, the investigators will explore the extent of myocardial reversible ischemia reduction and possible influence on hrECG markers of left ventricular arrhythmogenicity. 40 patients with refractory angina CCS class (Canadian cardiovascular society) II-IV and confirmed reversible ischemia will be included. Patients will be randomized into two groups. The first group will undergo CSR implantation procedure. The second group will present a sham control group with placebo procedure. At inclusion and after 6 months the investigators will perform cardiopulmonary exercise test (CPET), single photon emission tomography for detection of reversible ischemia (SPECT), high resolution ECG (hrECG), echocardiography and asses the subjective burden of angina according to CCS score and the quality of life according to the Seattle angina Questionnaire (SAQ).

Detailed Description

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Conditions

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Refractory Angina Pectoris

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Caregivers
Punction of the right internal jugular vein and CSR implantation procedure simulation.

Study Groups

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Treatment group

Coronary sinus reducer implantation through right internal jugular vein.

Group Type ACTIVE_COMPARATOR

Coronary Sinus Reducer device

Intervention Type DEVICE

Coronary sinus reducer device (Neovasc, Richomnd, Canada) implantation in the coronary sinus. The procedure is performed in the cardiac catheterization laboratory through right internal jugular vein.

Sham group

Puncture of the right internal jugular vein and simulation of the CSR implantation procedure.

Group Type SHAM_COMPARATOR

Sham procedure

Intervention Type OTHER

Puncture of the right internal jugular vein and simulation of the CSR implantation procedure.

Interventions

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Coronary Sinus Reducer device

Coronary sinus reducer device (Neovasc, Richomnd, Canada) implantation in the coronary sinus. The procedure is performed in the cardiac catheterization laboratory through right internal jugular vein.

Intervention Type DEVICE

Sham procedure

Puncture of the right internal jugular vein and simulation of the CSR implantation procedure.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* angina pectoris CCS class II-IV
* receiving optimal medical therapy for at least one month
* confirmed reversible myocardial ischemia in left anterior descending coronary artery (LAD) and/or left circumflex coronary artery (LCX) territory by SPECT
* not candidate for percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)

Exclusion Criteria

* recent non stable angina pectoris (within 1 months)
* recent acute coronary syndrome (within 3 months)
* recent successful PCI and/or CABG (within 6 months)
* decompensated heart failure and/or recent (within 3 months) hospitalization due to heart failure
* severe heart valve(s) disease
* advanced chronic obstructive pulmonary disease (COPD) or poorly managed asthma
* peripheral arterial disease, musculoskeletal disorder or central nervous system disease which preclude exercise testing
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Medical Centre Ljubljana

OTHER

Sponsor Role lead

Responsible Party

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Matjaž Bunc

Head of catheterization laboratory

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Matjaž Bunc, Prof.

Role: PRINCIPAL_INVESTIGATOR

University Medical Centre Ljubljana, Slovenia

David Žižek, Assoc. Prof.

Role: STUDY_CHAIR

University Medical Centre Ljubljana, Slovenia

Locations

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University Medical Centre Ljubljana

Ljubljana, , Slovenia

Site Status

Countries

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Slovenia

References

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Mannheimer C, Camici P, Chester MR, Collins A, DeJongste M, Eliasson T, Follath F, Hellemans I, Herlitz J, Luscher T, Pasic M, Thelle D. The problem of chronic refractory angina; report from the ESC Joint Study Group on the Treatment of Refractory Angina. Eur Heart J. 2002 Mar;23(5):355-70. doi: 10.1053/euhj.2001.2706. No abstract available.

Reference Type BACKGROUND
PMID: 11846493 (View on PubMed)

Henry TD, Satran D, Hodges JS, Johnson RK, Poulose AK, Campbell AR, Garberich RF, Bart BA, Olson RE, Boisjolie CR, Harvey KL, Arndt TL, Traverse JH. Long-term survival in patients with refractory angina. Eur Heart J. 2013 Sep;34(34):2683-8. doi: 10.1093/eurheartj/eht165. Epub 2013 May 12.

Reference Type BACKGROUND
PMID: 23671156 (View on PubMed)

Giannini F, Aurelio A, Jabbour RJ, Ferri L, Colombo A, Latib A. The coronary sinus reducer: clinical evidence and technical aspects. Expert Rev Cardiovasc Ther. 2017 Jan;15(1):47-58. doi: 10.1080/14779072.2017.1270755.

Reference Type BACKGROUND
PMID: 27935738 (View on PubMed)

Konigstein M, Verheye S, Jolicoeur EM, Banai S. Narrowing of the Coronary Sinus: A Device-Based Therapy for Persistent Angina Pectoris. Cardiol Rev. 2016 Sep-Oct;24(5):238-43. doi: 10.1097/CRD.0000000000000101.

Reference Type BACKGROUND
PMID: 26886464 (View on PubMed)

Verheye S, Jolicoeur EM, Behan MW, Pettersson T, Sainsbury P, Hill J, Vrolix M, Agostoni P, Engstrom T, Labinaz M, de Silva R, Schwartz M, Meyten N, Uren NG, Doucet S, Tanguay JF, Lindsay S, Henry TD, White CJ, Edelman ER, Banai S. Efficacy of a device to narrow the coronary sinus in refractory angina. N Engl J Med. 2015 Feb 5;372(6):519-27. doi: 10.1056/NEJMoa1402556.

Reference Type BACKGROUND
PMID: 25651246 (View on PubMed)

Konigstein M, Meyten N, Verheye S, Schwartz M, Banai S. Transcatheter treatment for refractory angina with the Coronary Sinus Reducer. EuroIntervention. 2014 Feb;9(10):1158-64. doi: 10.4244/EIJV9I10A196.

Reference Type BACKGROUND
PMID: 24561732 (View on PubMed)

Abawi M, Nijhoff F, Stella PR, Voskuil M, Benedetto D, Doevendans PA, Agostoni P. Safety and efficacy of a device to narrow the coronary sinus for the treatment of refractory angina: A single-centre real-world experience. Neth Heart J. 2016 Sep;24(9):544-51. doi: 10.1007/s12471-016-0862-2.

Reference Type BACKGROUND
PMID: 27299456 (View on PubMed)

Banai S, Ben Muvhar S, Parikh KH, Medina A, Sievert H, Seth A, Tsehori J, Paz Y, Sheinfeld A, Keren G. Coronary sinus reducer stent for the treatment of chronic refractory angina pectoris: a prospective, open-label, multicenter, safety feasibility first-in-man study. J Am Coll Cardiol. 2007 May 1;49(17):1783-9. doi: 10.1016/j.jacc.2007.01.061.

Reference Type BACKGROUND
PMID: 17466229 (View on PubMed)

Myers J, Froelicher VF. Optimizing the exercise test for pharmacological investigations. Circulation. 1990 Nov;82(5):1839-46. doi: 10.1161/01.cir.82.5.1839.

Reference Type BACKGROUND
PMID: 2225380 (View on PubMed)

Kralios AC, Nappi JM, Tsagaris TJ, Kralios FA, Kuida H. Paradoxical increase of ventricular fibrillation threshold in response to coronary sinus obstruction. Am Heart J. 1988 Feb;115(2):334-40. doi: 10.1016/0002-8703(88)90479-6.

Reference Type BACKGROUND
PMID: 3341168 (View on PubMed)

Kralios AC, Anderson FL, Kralios FA. Protective effect of coronary sinus obstruction from primary ischemia-induced ventricular fibrillation in the dog. Am Heart J. 1993 Apr;125(4):987-95. doi: 10.1016/0002-8703(93)90105-i.

Reference Type BACKGROUND
PMID: 8465771 (View on PubMed)

De Maria GL, Kassimis G, Raina T, Banning AP. Reconsidering the back door approach by targeting the coronary sinus in ischaemic heart disease. Heart. 2016 Aug 15;102(16):1263-9. doi: 10.1136/heartjnl-2016-309642. Epub 2016 Jun 10.

Reference Type BACKGROUND
PMID: 27288281 (View on PubMed)

Baldetti L, Colombo A, Banai S, Latib A, Esposito A, Palmisano A, Giannini F. Coronary sinus Reducer non-responders: insights and perspectives. EuroIntervention. 2018 Feb 20;13(14):1667-1669. doi: 10.4244/EIJ-D-17-00626.

Reference Type BACKGROUND
PMID: 29086709 (View on PubMed)

Mrak M, Zlahtic T, Starc V, Ivanovski M, Bunc M, Zizek D. The Impact of Coronary Sinus Reducer on Arrhythmic Properties in Patients with Refractory Angina. Rev Cardiovasc Med. 2023 Dec 26;24(12):368. doi: 10.31083/j.rcm2412368. eCollection 2023 Dec.

Reference Type DERIVED
PMID: 39077099 (View on PubMed)

Other Identifiers

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CrossRoad

Identifier Type: -

Identifier Source: org_study_id

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