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Therapeutics
PCI does not improve outcomes for patients with stable angina
  1. Paul D Morris1,2,3,
  2. David R Warriner4
  1. 1Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Science., University of Sheffield, Sheffield, UK
  2. 2Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  3. 3Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
  4. 4Cardiology Department, Leeds Teaching Hospitals Trust, Leeds, UK
  1. Correspondence to Dr David R Warriner, Leeds Teaching Hospitals Trust, Leeds LS1 3EX, UK; david.warriner{at}nhs.net

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Commentary on: Al-Lamee R, Thompson D, Dehbi HM, et al. Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet 2017;391:31-40.

Context

More than 500 000 percutaneous coronary intervention (PCI) procedures are performed worldwide each year for stable coronary artery disease (CAD). In addition to medical therapy, physiologically targeted PCI reduces urgent revascularisation in this group1; however, unlike in acute coronary syndromes, evidence supporting a reduction in myocardial infarction and mortality is lacking,2 especially in those with low ischaemic burden.3 Consequently, in stable CAD, PCI is used predominantly for symptomatic relief. It is therefore remarkable that, 40 years after Andreas Grüntzig’s first PCI, we only now have results of the first double-blind, placebo-controlled trial of PCI in stable angina: the Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina (ORBITA) trial.4

Methods

Patients with stable angina and single-vessel …

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