PCI, the Antianginal 'Pill': ORBITA-2 in Detail

This transcript has been edited for clarity.

Michelle L. O'Donoghue, MD, MPH: Hi. This is Dr Michelle O'Donoghue, reporting for Medscape. We're here in Philadelphia at the American Heart Association Scientific Sessions where one of the big stories has been ORBITA-2. The primary results were presented. Joining me here today are Rasha Al-Lamee and Chris Rajkumar, both from Imperial College in the UK. Before we talk about ORBITA-2, perhaps you could set the stage, Rasha; where were we at after ORBITA-1? What were the takeaways there?

ORBITA-1 Recap

Rasha Al-Lamee, MBBS, MA, PhD: Thank you very much, Michelle, for having us here. After ORBITA-1, you will remember well the fallout that came. Obviously, it was the first placebo-controlled trial of stable coronary artery disease and percutaneous coronary intervention (PCI), comparing PCI with a placebo procedure in patients who had guideline-directed medical therapy.

Importantly, the patients were on an average of three antianginal agents prior to being randomized. And what we found was that the benefit of angioplasty above placebo was far smaller than we expected, and in fact, not statistically significant on the primary endpoint of exercise time. Broadly, there was very little to talk to in terms of symptom relief; one in five more patients were free of angina.