The efficacy and safety of coronary sinus reducer in refractory angina: a systematic review and meta-analysis
Bibliographic record
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.010 | 0.007 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".