PCI delivers better angina relief in focal vs diffuse CAD

Percutaneous coronary intervention (PCI) achieves greater symptom improvement in focal vs diffuse coronary artery disease (CAD), as shown in the ORBITA-2 study.

ORBITA-2, a randomized placebo-controlled trial of angioplasty for stable angina, included 245 patients who underwent prerandomization nonhyperemic pressure wire pullback assessments. Seven blinded interventional cardiologists independently reviewed each pullback trace to categorize disease patterns as focal, diffuse, or mixed, which were then assigned numerical values of 1, 0, and 0.5, respectively.

The authors determined overall disease pattern score by the mean. A score of >0.5 was deemed focal and ≤0.5 diffuse. Bayesian proportional odds modelling was utilized.

A total of 300 target vessel pullbacks were analysed. PCI in focal vs diffuse CAD demonstrated greater improvement in angina symptom score (odds ratio [OR], 1.80, 95 percent credible interval [Crl], 1.48‒2.18; Pr[Benefit]>99.9 percent) and daily angina episodes (OR, 1.55, 95 percent CrL, 1.26‒1.89; Pr[Benefit]>99.9 percent), with adjustment for prerandomization nonhyperemic pressure ratio.

Furthermore, focal disease predicted greater placebo-controlled benefit in exercise treadmill time (Pr[Interaction]>99.9 percent), Canadian Cardiovascular Society class (Pr[Interaction]=99.0 percent), EuroQol Group 5-Dimensions 5-Level questionnaire (Pr[Interaction]=95.1 percent), and Seattle Angina Questionnaire angina frequency (Pr[Interaction]=99.5 percent).

A weaker evidence of interaction was also noted between disease pattern and the placebo-controlled impact of PCI on improvement in dobutamine stress echocardiography score (Pr[Interaction]=83 percent).

“Physiological patterns of disease may be useful to guide treatment decision making with PCI for symptom relief,” the authors said.