WASHINGTON — Findings from the REMEDY-PILOT trial indicate that implanting a coronary sinus reducer does not significantly improve myocardial perfusion reserve, symptoms, or quality of life for patients suffering from coronary microvascular dysfunction and angina with nonobstructive coronary arteries.

REMEDY-PILOT Trial Results Presented at TCT 2026

The study, presented at the Transcatheter Cardiovascular Therapeutics (TCT) 2026 conference, evaluated 54 patients between May 2023 and February 2026. Participants featured cases of refractory angina with nonobstructive coronary arteries (ANOCA) alongside reduced myocardial perfusion reserve (MPR). Approximately 90% of the cohort were classified under chronic coronary syndrome class III or IV despite managing a median of four anti-anginal medications.

Researchers randomized the patients to undergo either a coronary sinus reducer (CSR) implantation or a sham procedure, tracking outcomes across a six-month follow-up period. The trial's primary endpoint—measuring the change in segmental endocardial MPR at six months—revealed no significant improvement, showing an adjusted treatment effect of –0.03.

Additional secondary endpoints, including the endocardial-to-epicardial ratio during stress and patient-reported daily angina episodes, likewise displayed no statistically significant differences between the two study groups. While a slight improvement appeared in chronic coronary syndrome class measures for patients treated with the reducer, Seattle Angina Questionnaire domains showed no significant divergences.

Dr. Kevin Cheng noted that while the procedure proved safe, the trial data failed to demonstrate notable enhancements in cardiovascular magnetic resonance perfusion metrics, symptoms, or quality of life relative to sham procedures for patients who presently lack other evidence-based treatment options. Chief Investigator Dr. Ranil de Silva stated that researchers intend to complement these primary findings using data from an invasive coronary thermodilution mechanistic substudy, noting that further randomized, double-blind, placebo-controlled investigations will be necessary to establish any future role for reducer therapies in treating microvascular dysfunction.