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General medicine
Has too much cardiology been sent into the appropriateness ORBITA?
  1. David R Warriner1,
  2. Jack William O’Sullivan2
  1. 1 Cardiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2 Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Dr. David R Warriner, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK; david.warriner{at}nhs.net

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The 2017, the Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina (ORBITA) trial by Al-Lamee et al 1 was the first double-blind, randomised, sham-controlled trial to investigate the role of percutaneous coronary intervention (PCI) for the treatment of stable angina. It showed no significant difference in exercise tolerance between patients treated with a sham procedure (placebo) and with PCI. Further, patients who underwent PCI had no improvements in other exercise outcomes, nor with any patient-reported endpoints. The results from the ORBITA trial have important implications for clinical practice and research.

The ORBITA trial questioned what has now become routine clinical practice, namely PCI for patients with stable angina. The results suggest that patients who undergo PCI for stable angina accept a small, but not insignificant, risk of harm for no benefit. It is hard to imagine a scenario where a fully informed patient would …

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