Episode # 14 • 11 Nov 2025
COSIRA II: Refractory Angina Challenges & Treatment Strategies
with Dr. Jai Khatri, 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.
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Timestamps
00:00 - Introduction
01:42 - Understanding Refractory Angina
03:36 - Diagnostic Approaches
06:32 - Medical Therapy for Angina
10:29 - Complex Cases and Treatment Strategies
18:00 - Coronary Sinus Reducer
27:11 - Understanding the Risks and Learning Curve
28:06 - The COSIRA II Trial
30:27 - Tips for Patient Recruitment and Management
33:05 - Handling Treadmill Tests and Patient Communication
38:10 - Referral Patterns and Inter-Institutional Collaborations
45:38 - Future of Coronary Sinus Reducer
50:33 - Final Thoughts
Resources
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More about this episode
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.
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