Why the study?
Whether the efficacy of percutaneous coronary intervention for symptom relief in patients with stable coronary artery disease is consistent across age groups remained unknown.
Does percutaneous coronary intervention reduce angina episodes and improve exercise time across different age groups in patients with stable coronary artery disease?
RCT
placebo-controlled
randomized
Does percutaneous coronary intervention reduce angina episodes and improve exercise time across different age groups in patients with stable coronary artery disease?
PCI effectively reduces angina frequency across all age groups in stable CAD, though improvements in treadmill exercise time are significantly attenuated in older patients.
Answers are grounded in this paper and cite their sources.
Supports age-informed counseling on PCI for angina relief versus exercise gains in stable CAD; extends ORBITA-2 with age-interaction data.
Background Percutaneous coronary intervention (PCI) is recommended for symptom relief in patients with angina and stable coronary artery disease. ORBITA-2 was the first randomized, placebo-controlled trial to assess its efficacy in patients with stable angina, single or multivessel coronary artery disease, without a background of antianginal medication. Whether the effect is consistent across age groups remains unknown. Purpose To evaluate the efficacy of PCI across age groups on the ORBITA-2 primary and secondary endpoints, including angina episodes, quality of life, and treadmill exercise time. Methods All patients from the primary ORBITA-2 analysis contributed data to this analysis. Age was added as an interacting factor with treatment arm to the original models. For the daily symptoms, a Bayesian longitudinal Markov model was constructed; for the treadmill exercise time and questionnaires, a Bayesian ordinal proportional odds model including the pre-randomization and treatment arm, which was allowed to interact with age. Results The median age was 64±9 years. PCI reduced the number of angina episodes more in older (OR=2.0, 95%CrI 1.7 to 2.4, Pr=0.99) than in younger patients (OR=1.7, 95%CrI 1.7 to 2.1, Pr=0.99; Pr(Interaction)=0.99). PCI led to an improvement in Seattle Angina Questionnaire angina frequency, irrespective of age Pr(Interaction)=0.524. In contrast, the effect of PCI on treadmill exercise time was greater in younger than in older patients (125s 95%CrI 35.8 to 215, Pr=0.997 vs 31.9s 95%CrI 78.3 to -12.6, Pr=0.918; Pr(Interaction)=0.962). The effect of PCI in patients with Rose Angina was consistent across all age groups Pr(Interaction)=0.488. Conclusion PCI was effective across all ages in reducing the frequency of angina. However, the treadmill exercise time in older patients did not improve with PCI. To ensure the generalisability of results in all ages, these data should inform the choice of endpoints for cardiovascular clinical trials.
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Simader et al. (2025) conducted an RCT in stable coronary artery disease. Percutaneous coronary intervention (PCI) vs. placebo was evaluated on angina episodes (OR 2.0 (older), OR 1.7 (younger), 95% CI 1.7-2.4 (older), 1.7-2.1 (younger), p=Pr(Interaction)=0.99).
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