Post-percutaneous coronary intervention angina in stable coronary artery disease

This editorial refers to ‘The incidence and relevance of site-reported vs. patient-reported angina: insights from the ABSORB II randomized trial comparing Absorb everolimus-eluting bioresorbable scaffold with XIENCE everolimus-eluting metallic stent’, by M.J. Grundeken et al., on page 108 . Percutaneous coronary intervention (PCI) is an important form of revascularization therapy that has potential benefits but also significant risks. In patients with an acute coronary syndrome presentation, the risks of a major adverse cardiac event (MACE—i.e. death and myocardial infarction) are substantial and improved with early intervention, so that the benefits outweigh the risks.1,2 Accordingly, the use of PCI in acute coronary syndrome is readily justified and is reflected in appropriateness use criteria.3 In contrast, patients with stable coronary artery disease (CAD) have a low risk of MACE and several studies have confirmed that PCI does not reduce the risk of MACE in these patients.4,5 Whether the selection of a high-risk stable CAD cohort (i.e. those with significant CAD and a documented moderate zone of ischaemia) for PCI will result in an improvement in MACE is the focus of the ongoing ISCHEMIA trial.6 In the interim, the benefits of PCI in patients with stable CAD need to focus on symptomatic improvement rather than a reduction in cardiac events. Clinical efficacy studies of PCI in patients with stable CAD have demonstrated an incremental benefit of alleviating angina symptoms over medical therapy. The most influential and contemporary of these randomized controlled trials is a sub-study of the COURAGE trial. In this investigation, Weintraub et al .7 demonstrated a small incremental benefit of PCI over optimal medical therapy alone in alleviating angina, although this treatment difference was lost … [↵][1]*Corresponding author. Tel: +61 8 8222 6740, Fax: +61 8 8222 6042, Email: john.beltrame{at}adelaide.edu.au [1]: #xref-corresp-1-1