Ep. 14 COSIRA II: Refractory Angina Challenges & Treatment Strategies with Dr. Jai Khatri and Dr. Ziad Ali

Sham-controlled, randomized, and double-blind: the COSIRA II trial has the makings to make big waves in the management of refractory angina. This week’s episode features two interventionalists that are well-versed in coronary sinus reducers and the trials investigating them. Dr. Ziad Ali, from St. Francis Hospital and Heart Center in New York, and Dr. Jai Khatri, with Weill Cornell Medicine, join BackTable Cardiology to discuss the challenges and potential solutions in treating refractory angina in interventional cardiology. --- This podcast is supported by: Shockwave Reducerhttps://shockwavemedical.com/clinical-evidence/cosira-ii/ --- SYNPOSIS The doctors cover the current approaches to managing chronic angina before and after PCI, discuss how to differentiate ischemic heart disease from non-ischemic chest pain, and address the burdens faced by patients with complex atherosclerotic disease. A significant focus of the episode is on the role of the coronary sinus reducer, including procedure technique, risks, benefits, and its potential for treating both obstructive coronary artery disease and microvascular disease. The doctors also explore the logistics and challenges of enrolling patients in the COSIRA-II trial and speculate on the future impact of this device in clinical practice. --- TIMESTAMPS 00:00 - Introduction01:42 - Understanding Refractory Angina03:36 - Diagnostic Approaches06:32 - Medical Therapy for Angina10:29 - Complex Cases and Treatment Strategies18:00 - Coronary Sinus Reducer27:11 - Understanding the Risks and Learning Curve28:06 - The COSIRA II Trial30:27 - Tips for Patient Recruitment and Management33:05 - Handling Treadmill Tests and Patient Communication38:10 - Referral Patterns and Inter-Institutional Collaborations45:38 - Future of Coronary Sinus Reducer50:33 - Final Thoughts --- RESOURCES Dr. Ziad Alihttps://ziadalimd.com/ Dr. Jai Khatrihttps://doctors.nyp.org/jaikirshan-khatri-md/cardiology-weill-greenberg-center COSIRA Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1402556 COSIRA II Trial https://clinicaltrials.gov/study/NCT05102019