PCI May Not Actually Benefit Stable Angina Outcomes

In patients with stable angina and severe coronary stenosis, undergoing percutaneous coronary intervention (PCI) did not increase exercise time more than sham procedure, according to the results of a recent study.

Although PCI is commonly used for symptom relief in patients with stable angina, there is no evidence from blinded, placebo-controlled trials showing the efficacy of the procedure in this population, according to the study authors.
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For their blinded, multicenter, randomized trial, researchers enrolled patients with severe single-vessel stenosis. Participants received 6 weeks of medication optimization, then had pre-randomization assessments with cardiopulmonary exercise testing, symptom questionnaires, and dobutamine stress echocardiography.

The participants were randomized 1:1 to undergo either PCI or sham procedure. After 6 weeks, the researchers repeated all assessments that had been conducted preoperatively. Difference in exercise time increment between groups was the primary endpoint of the study.

Overall, 105 patients were assigned to PCI and 95 were assigned to the sham procedure. The researchers observed no differences in the primary endpoint between the 2 groups.

“In patients with medically treated angina and severe coronary stenosis, PCI did not increase exercise time by more than the effect of a placebo procedure. The efficacy of invasive procedures can be assessed with a placebo control, as is standard for pharmacotherapy,” the researchers concluded.

—Michael Potts

Reference:

Al-Lamee R, Thompson D, Dehbi H, et al. Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial [published online November 2, 2018. Lancet. doi:http://dx.doi.org/10.1016/S0140-6736(17)32714-9.