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COURAGE, ORBITA, and ISCHEMIA: Percutaneous Coronary Intervention for Stable Coronary Artery Disease

Zhi Teoh1, Rasha K Al-Lamee2

  • 1Barts Health NHS Trust, The Royal London Hospital, 80 Newark Street, London E1 2ES, UK.

Interventional Cardiology Clinics
|September 14, 2020
PubMed

Insights

Percutaneous coronary intervention (PCI) primarily offers symptomatic relief for stable coronary artery disease (CAD), not improved survival. Risk-reducing medications are key for better outcomes in patients with CAD.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Stable coronary artery disease (CAD) management involves understanding the interplay between stenosis, ischemia, and angina.
  • Percutaneous coronary intervention (PCI) is a common revascularization strategy for CAD.

Purpose of the Study:

  • To review landmark trials evaluating the role of PCI in stable CAD.
  • To clarify the indications and outcomes associated with PCI in stable CAD.

Main Methods:

  • Review of pivotal clinical trials comparing PCI to medical therapy or placebo in stable CAD.
  • Analysis of data regarding anginal symptom relief, mortality, and myocardial infarction rates.

Main Results:

  • Anginal relief is the primary benefit of PCI in stable CAD.
  • PCI has not demonstrated significant improvements in mortality or myocardial infarction rates, even with substantial ischemia.
  • Placebo effects appear significant in PCI trials for stable CAD.

Conclusions:

  • PCI in stable CAD is mainly indicated for symptom management.
  • Optimal medical therapy remains crucial for improving long-term outcomes and reducing cardiovascular events in stable CAD.
  • Further research may refine the selection of patients who benefit most from PCI.

Keywords:
AnginaChronic coronary artery diseaseIschemiaPercutaneous coronary interventionPlacebo

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