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Study: PCI Appears No Better Than Sham Procedure in Patients with Stable Angina

Posted: Fri Nov 03, 2017 8:22 pm
by ecpforum
Study: PCI Appears No Better Than Sham Procedure in Patients with Stable Angina
By Kelly Young
Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS

Percutaneous coronary intervention (PCI) didn't improve exercise time relative to a sham procedure in patients with stable angina and severe coronary stenosis. Findings from the ORBITA study were published in the Lancet and presented at the Transcatheter Cardiovascular Therapeutics conference on Thursday.
Two hundred patients with stable angina and at least one significant lesion (70% blockage or more) in a single vessel received 6 weeks of optimized antianginal medication. They also underwent treadmill exercise tests until they developed limiting symptoms, heart rhythm or blood pressure abnormalities, or significant ST-segment deviations. Patients were then randomized to undergo PCI with drug-eluting stents, or to receive a sham procedure in which they were sedated for at least 15 minutes and had their coronary catheter withdrawn without intervention.

Six weeks after PCI or sham, patients repeated the treadmill test. The change in exercise time did not differ significantly between the PCI and sham groups. Other exercise and patient-centered outcomes also were not improved with PCI.

Dr. Harlan Krumholz of NEJM Journal Watch Cardiology comments: "This remarkable, albeit small, study questions some key assumptions we have about the benefit of PCI in patients with stable angina — and also provokes questions about the need to evaluate interventions and devices with sham controls. Patients with stable angina considering PCI deserve to know about this study."

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