PCI Benefit in Angina Clarified in New ORBITA-2 Analysis

"Symptoms — not the severity of disease — is what powerfully predicts the clinical benefit from PCI," Florentina A. Simadar, MD, a cardiologist with the Imperial College London, United Kingdom, reported at the Congress of the European Association of Percutaneous Coronary Interventions 2024.

In the double-blind sham-controlled ORBITA-2 trial, patients with stable angina were evaluated when they were off antianginal therapy. At the end of 12 weeks, the mean daily angina score in the PCI group was half the score in the placebo group, a result associated with a more than twofold increase in the odds ratio of a reduction in angina (OR, 2.

"There was little relationship" between angina defined by these criteria and anatomical disease severity measured with quantitative coronary angiography, or between angina and the severity of ischemia measured with stressThese findings fundamentally alter the goal of revascularization performed to relieve angina. It has been reasonably thought for decades that stenotic lesions were the source of symptoms and that relieving the obstruction would relieve the angina.

"The findings do suggest that greater focus on ascertaining the quality of the patient's symptoms, rather than anatomical or physiological measures, could improve shared decision-making" about whether PCI is an appropriate step, Yeh and his fellow editorialist, Christina Lalani, MD, cardiology fellow at Beth Israel Deaconess Medical Center, wrote.

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