DENVER, CO — Among patients with stable angina, even with severe coronary stenosis, exercise capacity and symptom relief were no better after PCI for single-vessel disease than a sham procedure in the first-ever sham-controlled PCI trial[1].
Dr Rasha Al Lamee
"I think that the correlation between a tight epicardial stenosis that we see, relieving ischemia, and hopefully improving symptoms may be more complex than just performing angioplasty," lead investigator Dr Rasha Al-Lamee (Imperial College London, UK) told theheart.org | Medscape Cardiology. "Perhaps some of these patients have microvascular disease, they may have noncardiac chest pain, they may have other reasons why they come back."
She stressed that the results of ORBITA, presented amid a 40th anniversary celebration for PCI at TCT 2017 and simultaneously published in the Lancet, need to be taken in context. The patients had single-vessel disease, and to extrapolate the results to patients with multivessel disease and a higher ischemic burden would be a mistake.
The results may also have been different if they had added an invasive physiological assessment rather than using angiography alone to guide PCI, albeit in line with common practice, she said.
Reaction to the trial was swift, with headlines splashed across national news outlets and a tsunami of Tweets fiercely debating its merits.
