冠状动脉窦缩减器植入治疗难治性心绞痛：英国全国实践审计
结果显示95%手术成功，围术期不良事件发生率9.2%，主要心血管不良事件和严重不良事件均低于1%，6个月随访时75%患者CCS分级改善至少1级，36%改善至少2级。
要点
- CSR植入在英国真实世界中用于难治性心绞痛患者，手术成功率达95%。
- 围术期不良事件发生率9.2%，主要为血管入路并发症，严重不良事件罕见。
- 6个月随访时75%患者CCS分级改善≥1级，36%改善≥2级。
核心结论
- 英国全国审计证实CSR植入用于难治性心绞痛患者选择适当、手术安全且能改善症状。
主要发现
- 患者中男性占79%，既往心肌梗死75%、经皮冠状动脉介入治疗78%、冠状动脉旁路移植术69%。
- 合并症常见：糖尿病53%、高血压76%、高胆固醇血症78%；74%患者左心室射血分数保留（LVEF≥50%）。
- 患者症状严重：84%为加拿大心血管学会（CCS）心绞痛分级≥3级，94%使用≥2种抗心绞痛药物，74%使用≥3种。
- 基线缺血评估常见（79%）；CSR植入成功率达95%。
- 41例患者发生46例围术期不良事件（9.2%），最常见为入路并发症；主要心血管不良事件和严重不良事件发生率均低于1%；98%患者术后住院≤1晚。
临床怎么用
- 对于优化药物治疗后仍有症状的难治性心绞痛患者，CSR植入是可行、安全且能改善症状的经皮治疗选择。
- 当代英国实践与现行指南推荐一致，支持CSR在英国临床实践中的持续使用。
局限性
- 研究为回顾性全国审计，非前瞻性设计，数据收集依赖各中心结构化模板。
- 作者指出有必要在国家注册登记中进行前瞻性数据收集。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
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.
引用
- Cheng K, Witherow F, Byrne J, et al. Coronary sinus reducer implantation for refractory angina: a national audit of UK practice. Heart. 2026. PMID: 42191180. doi:10.1136/heartjnl-2025-327497
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。