Intended for healthcare professionals


Coronary intervention for stable angina

BMJ 2018; 363 doi: (Published 27 December 2018) Cite this as: BMJ 2018;363:k5351
  1. Adam Timmis, professor of clinical cardiology1 2,
  2. Andrew Wragg, consultant cardiologist1 2
  1. 1Barts and The London School of Medicine and Dentistry, Queen Mary University London, UK
  2. 2Barts Heart Centre, West Smithfield, London, UK
  1. Corresponding author: a.d.timmis{at}

ORBITA challenges cardiologists to be more rigorous in their selection of patients for PCI

More than 10 years ago, the randomised Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial showed that percutaneous coronary intervention (PCI) had no effect on the risk of death or myocardial infarction when added to optimal medical therapy in patients with stable coronary artery disease.1 The failure to improve prognosis was, in retrospect, predictable for an intervention that does nothing to modify the atherothrombotic disease process2 but it left undented a clinical enthusiasm for PCI as a means of restoring coronary perfusion and relieving exertional angina.

Belief in the symptomatic benefits of PCI has now been shaken by the publication of the Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina (ORBITA) trial which found that PCI improved exercise tolerance no more than a placebo in stable patients already optimally treated with drugs. ORBITA has triggered a fierce and unresolved debate about how best to manage patients with stable coronary artery disease.3

ORBITA randomised 200 patients with stable angina to medical therapy alone or medical therapy plus …

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