The placebo-controlled benefit of percutaneous coronary intervention was greater in patients with lower microvascular resistance.
RCT
Blinded
Randomized
Does PCI improve symptoms and exercise capacity compared to placebo in stable angina patients with low microvascular resistance?
In patients with stable angina, lower microvascular resistance predicts a greater placebo-controlled symptom and exercise benefit from percutaneous coronary intervention.
BACKGROUND: The first placebo-controlled trial of percutaneous coronary intervention (PCI), ORBITA (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina; NCT02062593), showed minimal symptom benefit with PCI. No placebo-controlled data describing the relationship between microvascular resistance (MVR) and PCI exist. The authors hypothesized that patients with low MVR would derive the greatest benefit from PCI. OBJECTIVES: The aims of this study were to compute MVR in patients recruited for ORBITA and to evaluate interactions with prespecified endpoints. METHODS: Hyperemic MVR was calculated using computational fluid dynamics (CFD) and compared against placebo-controlled changes in treadmill exercise time, patient-reported symptoms, physician-assessed symptoms, and dobutamine stress echocardiography scores at 6-week follow-up. RESULTS: MVR CONCLUSIONS: The placebo-controlled benefit of PCI was greater in patients with lower MVR
“The ability to better identify those likely to derive benefit from PCI and those who may be better suited to medical therapy alone is clearly beneficial but requires prospective evaluation, including MVR diagnostic threshold determination for dichotomizing patients.”
Taylor et al. (Wed,) conducted a rct in Stable Angina. Percutaneous coronary intervention (PCI) vs. Placebo was evaluated on Placebo-controlled changes in treadmill exercise time, patient-reported symptoms, physician-assessed symptoms, and dobutamine stress echocardiography scores. The placebo-controlled benefit of percutaneous coronary intervention was greater in patients with lower microvascular resistance.