International Journal of Clinical Case Reports 2024, Vol.14, No.2, 63-65 http://medscipublisher.com/index.php/ijccr 63 Scientific Commentary Open Access Exploring Coronary Sinus Downsizing for Angina Treatment: Lessons from the ORBITA-COSMIC Experience Zhaoyi Zhao Cuixi Academy of Biotechnology, Zhuji, 311800, Zhejiang, China Corresponding email: ssoy1@outlook.com International Journal of Clinical Case Reports, 2024, Vol.14, No.2 doi: 10.5376/ijccr.2024.14.0008 Received: 22 Apr., 2024 Accepted: 29 Apr., 2024 Published: 03 May. 2024 Copyright © 2024 Zhao, This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Preferred citation for this article: Zhao Z.Y., 2024, Exploring coronary sinus downsizing for angina treatment: lessons from the ORBITA-COSMIC experience, International Journal of Clinical Case Reports, 14(2): 63-65 (doi: 10.5376/ijccr.2024.14.0008) The paper "Coronary sinus reducer for the treatment of refractory angina (ORBITA-COSMIC), published in The Lancet on April 20, 2024: a randomised, placebo-controlled trial", Written by Michael J. Foley, Christopher A. Rajkumar, F. Ahmed-Jushuf, et al. From Imperial College London, Midlands and South Essex NHS Foundation Trust, Anglia Ruskin University, etc. In this study, the researchers investigated the effects of coronary sinus reducers (CSR) in the treatment of refractory angina pectoris through the ORBITA-COSMIC trial. The study was conducted in six UK hospitals using a double-blind, randomized, placebo-controlled approach to assess the effectiveness of CSR compared to placebo in improving myocardial ischemia and angina symptoms. The study was conducted in patients over 18 years of age with stable coronary artery disease and myocardial ischemia who had no other treatment options. The results of the study showed that although the effect of CSR in improving myocardial blood flow was not significant, it had a significant effect compared to placebo in reducing the frequency of angina attacks. These findings provide a scientific basis for CSR as a new treatment option against angina pectoris. 1 Interpretation Experimental Data In the trial, 61 patients were enrolled in the study and 51 eligible patients were randomly assigned to the CSR and placebo groups. The results of the study showed that patients treated with CSR had a lower frequency of angina attacks six months after treatment. Specifically, the reduction ratio for daily angina attacks was 1.40, with a 95% confidence interval of 1.08 to 1.83, suggesting that CSR had a significant effect in reducing angina relative to placebo. In addition, major measures of myocardial blood flow did not differ significantly between the CSR group and the placebo group, suggesting that the benefits of CSR may be primarily reflected in improvements in angina symptoms. Figure 2 details the two main findings of the ORBITA-COSMIC trial. Figure A shows that there was no significant difference between the CSR group and the placebo group in terms of stress myocardial flow (MBF) at the site of myocardial ischemia. Figure B reveals the daily frequency of angina attacks in the CSR and placebo groups after random assignment, showing a significant reduction in angina attacks in the CSR group. Figure C shows a gradual increase in the odds ratio of CSR to placebo in reducing angina attacks over time, particularly at the end of the trial period, showing the long-term effect of CSR in reducing angina. 2 Insights of Research Findings Although the coronary sinus miniator failed to significantly improve myocardial blood flow, its results in significantly reducing angina attacks indicate its potential effectiveness as an anti-angina treatment. The Bayesian statistical approach in the study further confirms the potential benefits of CSR in reducing angina, particularly in patients who have no other treatment options. For these patients, CSR can be used as a complementary treatment, especially when traditional drug therapy is no longer effective.
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