Is Percutaneous Coronary Intervention Just an Expensive Placebo?

Among selected patients, percutaneous coronary intervention provided real symptomatic and functional benefits beyond those of a placebo.

Evidence supporting the use of percutaneous coronary intervention (PCI) for relief of angina symptoms is derived entirely from open-label studies, which are subject to the placebo effect. Also, a blinded clinical trial (ORBITA-1) failed to demonstrate an incremental benefit of PCI compared with placebo among patients receiving intensive antianginal medical therapy (NEJM JW Cardiol Nov 8 2017 and Lancet 2018; 391:31). As such, some have questioned whether PCI provides any meaningful benefit — an important issue given the cost and complication risks of these procedures.

To address this gap in knowledge, the partially industry-funded ORBITA-2 trial (NCT03742050) randomized 301 patients (mean age, 64 years; 21% women; 80% single-vessel disease) …

Reviewing Author

David J. Cohen, MD, MSc

Disclosures

Consultant/Advisory BoardMedtronic; Edwards Lifesciences; Abbott Vascular; Boston Scientific; St. Francis Hospital

Speaker’s BureauBoston Scientific; ZOLL Medical

Grant/Research SupportEdwards Lifesciences; Abbott Vascular; Boston Scientific; Corvia Medical; National Heart, Lung, and Blood Institute; Phillips, Inc.; St. Paul’s Hospital; V-Wave, Inc; ZOLL Medical; CathWorks, ANCORA

Editorial BoardsJACC; American Heart Journal; EuroIntervention; JSCAI; Structural Heart Journal

Leadership Positions in Professional SocietiesSociety of Thoracic Surgeons/American College of Cardiology TVT Registry (Co-Chair, Risk Model Development Committee); Cardiovascular Research Foundation (Co-Director, TCT Annual Meeting; Co-Director, New York Valves Annual Meeting)