Why is this study important?

The ORBITA-COSMIC trial looks at a coronary sinus reducer in patients with refractory angina. This is an important study because these patients are highly symptomatic and have no other option for revascularization. Similar to the ORBITA trial, this trial used a double-blinded enrollment, and half of the patients received a “sham” procedure.

What question was this study supposed to answer?

This study looks to address whether coronary sinus reduction achieves physiologic objective evidence (cardiac MRI) of improved perfusion, as well as symptoms of angina. 

What did the study show?

The study did not detect an objective improvement by cardiac MRI in patients who received the coronary sinus reducer (CSR) device over the placebo group. The CSR device group did ultimately have a small decrease in angina burden that was detectable at ten weeks and sustained out to 6 months. This study was impressive in its attempt to truly blind the patients and the treating physician. This remains a highly complicated cohort of patients to treat.