Coronary intervention for stable anginaBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k5351 (Published 27 December 2018) Cite this as: BMJ 2018;363:k5351
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The study by Stephen et al concludes that 1) PCI should be performed in only a certain subset of patients with acute or single coronary lesions; 2) the best therapeutic approach is OMT. But there is no evidence-based justification for adopting one therapeutic strategy over the over. Physicians must consider several sources of information for assessment of an individual patient’s clinical presentation, assessment of severity of ischemia and the patient’s precise coronary anatomy. It will be more reliable in making a decision for treatment of CAD patients. 
Another study also concluded that PCI done only in stable chronic or often mild angina patients gave the statistically significant results but PCI in multiple clinical scenario has limitations, so PCI needs to be emphasized. Utilization rate of PCI in patients with stable angina and preserved left ventricular function should lead to more cost-effective care of patients with stable coronary artery disease. On the other hand, medical therapy or optimal medical therapy used in CAD are anti-platelets, beta-blockers and ACE inhibitors, etc, and they have been proven to reduce the risk of complications of CAD. But medication can also have side effects and and its protective effect lasts only as long as it taken.
In the end, we have to conduct more studies or analyses regarding the use of PCI or OMT in CAD patients. PCI therapy is also dependent upon factors like the morbidity of patients and clinical severity of disease. In the article, we agree with the authors and Vikas Saini's suggestion from ORBITA’s conclusion about PCI use, that perhaps patients already relieved by OMT therapies captured most of the therapeutic opportunity. 
1. Saini V. The real lesson of ORBITA: the remarkable power of medical therapy. 11 October 2018. Health Affairs. www.healthaffairs.org/do/10.1377/hblog20181003.290533/full.
2. David R.Holme, JR, MD, FACC, Bernard J et.al. Percutaneous coronary intervention for chronic stable angina. JACC2008:534-43.
3. Stephen E Epstein MD, Julio A Panza MD. et al. percutaneous coronary intervention versus Medical therapy in stable coronary artery disease: The Unresolved Conundum;JACC.21october2013;993-98.
4. Informed Health online[internet].Cologne, Germany. Institute for Quality and Efficiency in health care (IQWiG)2006-Medication for the long-term treatment of coronary artery disease.2013Feb13.[updated 2017-Jul27].
Competing interests: No competing interests