ORBITA-2 confirms PCI as alternative to anti-anginal drugs in stable angina

Percutaneous coronary intervention (PCI) improved the angina symptom score, increased exercise capacity, and ameliorated quality-of-life in patients with stable angina and evidence of ischaemia, who were not using anti-anginal medication. The effect occurred immediately, was sustained over 12 weeks, and was consistent across endpoints.

The randomised, placebo-controlled ORBITA-2 trial (NCT03742050) included 301 participants with stable angina, either due to single-vessel or multivessel disease, with evidence of ischaemia, who were not on anti-anginal medication at baseline. The primary endpoint was the daily angina symptom score, including the measurement of episodes of angina, the use of anti-anginal units, and adverse cardiovascular outcomes such as unacceptable angina, acute coronary syndrome, and death. The lowest score (0) represents the best outcome, whereas the highest score (79) represents death. Dr Christopher Rajkumar (Imperial College London, UK) presented the long-awaited results.

“PCI improved the angina symptom score compared with placebo (OR 2.21; 95% CI 1.41–3.47; P<0.001),” said Dr Rajkumar. This effect was driven by a reduction in angina frequency (OR 3.44; 95% CI 2.00–5.91; P<0.001) but not by anti-anginal use (OR 1.21; 95% CI 0.70–2.10; P=0.5). The rates of unacceptable angina, ACS, or death were low and comparable between groups.

“Physicians now have a choice of 2 first-line, evidence-based pathways, either anti-anginal medication or PCI,” concluded Dr Rajkumar. Referring to the non-significant results of the ORBITA-1 trial, assessing PCI in patients with MI on anti-anginal medication, Dr Rajkumar argued that current guidelines that reserve PCI to patients on optimal anti-anginal medication may systematically select patients with the least to gain [2].

1. 
   
   1. Rajkumar C, et al. Percutaneous coronary intervention for stable angina (ORBITA-2): a randomised, placebo-controlled trial. LB02, AHA Scientific Sessions 2023, 10–12 November, Philadelphia, USA.
   2. Al-Lamee R, et al. Lancet. 2018;391(10115):31–40.

 

Medical writing support was provided by Robert van den Heuvel.
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Posted on 14 November, 202315 November, 2023