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Authors

  1. Rosenberg, Karen

Abstract

According to this study:

 

* The first blinded, placebo-controlled trial of percutaneous coronary intervention in patients with stable angina showed no significant difference in exercise time or angina symptom relief compared with patients who had a placebo intervention.

 

* However, the authors note that percutaneous coronary intervention shouldn't be ruled out for the management of stable angina.

 

 

Article Content

Although more than half a million percutaneous coronary intervention procedures are performed annually in patients who have stable angina, the efficacy of this treatment in relieving angina symptoms hasn't been tested in a placebo-controlled trial. A multicenter randomized, blinded trial in the United Kingdom was designed to evaluate the effects of percutaneous coronary intervention compared with placebo on angina symptoms and specifically on the amount of time patients who have stable angina devoted to exercise.

 

Patients eligible for the study had ischemic symptoms and at least one angiographically sig-nificant lesion (>= 70% stenosis) in a single vessel that was clinically appropriate for percutaneous coronary intervention. In the first, six-week phase of the study, guideline-recommended antianginal therapy was started and titrated upward; patients also received dual antiplatelet therapy. Patients then completed symptom questionnaires and underwent cardiopulmonary exercise testing and dobutamine stress echocardiography. After coronary angiography was performed, the 200 participating patients were randomized to either percutaneous coronary intervention or a placebo procedure; the testing that was done before randomization was repeated after six weeks.

 

No difference was found between the two groups in the primary end point-change in treadmill exercise time. Furthermore, no differences were found on most secondary end points, such as change in exercise time to 1 mm ST-segment depression, change in peak oxygen uptake, and angina severity, stability, and frequency, among other symptoms. However, the dobutamine stress echocardiography peak stress wall motion score index was significantly improved with percutaneous coronary intervention compared with placebo. No patients died during this trial.

 

The authors note that, despite these findings, percutaneous coronary intervention shouldn't be ruled out for the management of stable angina. They also point out that these results don't apply to the treatment of patients with acute coronary syndrome, for which the procedure has proven advantages.

 

REFERENCE

 

Al-Lamee R, et al Lancet 2017 Nov 2 [Epub ahead of print].