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

Abstract

QUESTION: In your opinion, what conclusions can be drawn from the 2 ORBITA trials?1,2 ANSWER: The ORBITA trials focus on a specific aspect of the management of patients with acute coronary syndrome: the benefit in terms of symptom relief of angina.1,2 The first ORBITA trial1 is a double-blind, randomized, multicenter clinical trial, with 230 patients with severe single-vessel disease and ischemic symptoms that analyzed whether percutaneous coronary intervention (PCI) was associated with an improvement in angina-free exercise time compared with a placebo procedure.1 There were no statistically significant differences in the primary endpoint (differences in exercise increment on the stress test) at the 6-week follow-up between the 2 groups. The second ORBITA trial2, a double-blind, multicenter clinical trial, randomized 301 patients with exertional angina to undergo PCI or a placebo procedure.2 The methodology differs from that of ORBITA trial: all patients discontinued antianginal medication 2 weeks before randomization and were only included if they experienced angina throughout this period (assessed by a complex scoring system through a mobile application).3 Only patients with at least 1 severe coronary stenosis confirmed through physiological assessment were included; additionally, the 2 groups underwent the intervention (which was simulated in the group treated with the placebo...