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Rethinking revascularization in patients with stable angina.
Ralf E Harskamp1, Duk-Woo Park2
1a Cardiovascular Disease Research Group of Department of General Practice, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands.
Expert Review of Cardiovascular Therapy
|January 18, 2018
Summary
Percutaneous coronary intervention (PCI) did not significantly improve exercise capacity or angina symptoms in stable patients compared to a placebo. This high-quality study suggests PCI may be overvalued for symptom relief in stable coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Percutaneous coronary intervention (PCI) is commonly believed to relieve symptoms and improve exercise capacity in stable angina patients.
- The ORBITA trial investigated this long-held perception using a rigorous, blinded, placebo-controlled design.
Purpose of the Study:
- To evaluate the effectiveness of PCI compared to a placebo in improving exercise tolerance and functional status in patients with stable angina.
Main Methods:
- A blinded, randomized, placebo-controlled trial involving 200 patients with stable angina.
- Comparison of PCI group versus a sham procedure (placebo).
Main Results:
- No significant differences were observed in exercise time, functional status, angina relief, or quality of life between the PCI and placebo groups.
- The neutral outcome suggests potential overvaluation of PCI for symptom relief, possibly influenced by placebo effects.
Conclusions:
- The ORBITA trial found no significant benefit of PCI over placebo for symptom relief and exercise capacity in stable angina.
- While not sufficient to change guidelines, the findings challenge current perceptions and warrant further investigation into the role of PCI.
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