Study shows implant reduces chest pain in patients with persistent angina
How effective is a novel implantable device at improving symptoms for patients with severe, persistent chest pain (refractory angina)? A UK-wide research collaboration, led by Royal Brompton Hospital and Imperial College London, set out to answer this question.
Cardiologist Dr Ranil de Silva and his team looked at how a device known as a coronary sinus reducer (CSR) is being used across the NHS to treat people living with refractory angina.
Refractory angina and CSR
Angina is a medical term that refers to chest pain or discomfort caused by reduced blood flow to the heart muscle. In people with refractory angina, these symptoms persist despite medication, stents or bypass surgery. This affects a significant number of people in the UK, with estimates suggesting up to 300,000 patients.
A CSR is a small, hourglass-shaped device that is implanted using a minimally invasive (keyhole) procedure. It works by gently narrowing a vein at the back of the heart, helping to redirect blood flow to areas of the heart muscle that are not getting enough oxygen. This approach can help reduce chest pain in people whose symptoms have not improved with other treatments.
At Royal Brompton Hospital, a specialist service for patients with complex angina has been developed over the past 15 years. The team has played a key role in major studies of this device and now offers this treatment to suitable patients within the NHS.
The study
To understand how well the CSR device performs in practice, Dr de Silva and his team collected data from 19 hospitals across the country, covering nearly 500 patients who received the CSR implant over a 10-year period.
They looked at how safe the procedure was, the success of implantation, and most importantly, whether it actually improved patients’ symptoms. By looking at outcomes over time, including changes in chest pain severity, the study provides detailed information on how this treatment performs in everyday care.
The study found that the procedure was both safe and effective in everyday NHS practice, with the implant successfully placed in most patients (around 95%), and serious complications were rare. Most patients were able to go home the same day or after just one night in hospital.
Importantly, many patients experienced improvement, with around 75% of patients reporting a noticeable reduction in the severity of their chest pain after 6 months. This benefit was observed in men and women, across different age groups and medical backgrounds, suggesting the treatment could help a wide range of patients.
This research is the largest reported national experience of CSR therapy worldwide to date and shows that it can offer meaningful symptom relief for many patients. For people whose daily lives are limited by ongoing symptoms despite other treatments, this offers a new option to help them feel better and live more comfortably.
Dr de Silva explained the importance of this research:
“This work further demonstrates the leading role the UK interventional cardiology community has played in the clinical evaluation of this new technology and its clinical adoption. We will continue to build on this experience by leading and contributing to new clinical trials of CSR, which will hopefully further shape the importance of this technology in clinical practice”.