Debate. “Orbiting” around the management of stable angina. The interventional cardiologist’s perspective

• Published in: REC, Interventional cardiology (Internet. English ed.) Interventional cardiology (Internet. English ed.), 2024-08, Vol.6 (3), p.235-237
• Main Author: Javier Martín Moreiras
• Format: Article
• Language: English
• ISSN: 2604-7322
• DOI: 10.24875/RECICE.M24000451

QUESTION: In your opinion, what conclusions can be drawn from the 2 ORBITA trials?1,2 ANSWER: The 2 ORBITA studies aim to settle the debate on the utility of coronary revascularization in patients with stable chronic angina and coronary artery lesions causing ischemia in that territory. The first ORBITA trial1-a double-blind, multicenter clinical trial published in 2018-randomized 230 patients with stable angina and at least 1 severe coronary stenosis (> 70%) to undergo percutaneous coronary intervention (PCI) or receive placebo to assess the symptom relief of angina. After being included in the study, both groups received a strategy of medical therapy optimization 6 weeks prior to randomization. There were no significant differences at the 6-month follow-up in the primary endpoint of exercise tolerance between the 2 groups. The authors concluded that the efficacy of invasive procedures should be determined with placebo control only (without pharmacological optimization). This is precisely what the recently published ORBITA-2 trial2 aimed to address. This trial randomized 301 patients in 14 centers in the United Kingdom to receive PCI or placebo. Two weeks before randomization, all antianginal drugs were discontinued. All patients were required to have significant coronary artery disease and evidence of ischemia in at least 1...