As a non-cardiologist, it has been interesting to observe the debate around the ORBITA study. Al-Lamee et al. conducted a well designed multicentre double blind trial of percutaneous coronary intervention (PCI) versus a placebo procedure for angina relief. Patients had severe single vessel disease with exertional symptoms. They were started on medication, then after 6 weeks randomised to PCI (105 patients) or placebo/sham procedure (95 patients).

No difference in the primary end-point, exercise time increment to symptoms, was noted after 6 weeks, suggesting drug treatment should be maximised in the management of stable angina, potentially denying a generation of interventional cardiologists a procedure to perform.

As you might imagine, much debate (see #ORBITA for highlights) and some detailed reviews of the paper and statistics have ensued. The study shows that placebo procedures are possible and trials can be designed in the same way as for pharmacological interventions. Some have suggested the study was underpowered to see a small number of differences in outcomes in this time period. However, the data seem to suggest drug therapy should be maximised first in stable angina, before implementing PCI with its known risks. These are quoted as a death rate of 0.65%, myocardial infarction (15%) and renal injury (13%). But what do I know? I’m a simple endocrinologist.

Read the full article in The Lancet doi:10.1016/ S0140-6736(17)32714-9.