brand logo

Am Fam Physician. 2024;109(5):477

Clinical Question

Does percutaneous coronary intervention (PCI) reduce the symptoms of stable angina compared with a placebo procedure in patients who are not taking antianginal medications?

Bottom Line

In patients with stable angina who are not taking antianginal medications, PCI is effective. The study results suggest that for patients who are able to tolerate a maximal antianginal medical regimen, there is little or no benefit to PCI, but for those unable to adhere to medication, PCI provides an important benefit. (Level of Evidence = 1b)


The original ORBITA trial compared PCI with placebo in patients who were taking guideline-directed antianginal medications and found that there was no additional benefit with PCI for symptoms or treadmill exercise time. However, the authors acknowledge that achieving guideline-directed maximal medical therapy in the real world can be challenging. In this study, the authors identified patients with stable angina, severe stenosis of at least one vessel, and evidence of ischemia. They asked patients to stop taking any antianginal medications; antihypertensive medications with antianginal effects were replaced with alternate agents. Dual antiplatelet agents and statins were still prescribed. During a 2-week run-in period, the patients reported episodes of angina, and if they had at least one episode (n = 301) they were randomized to receive PCI or a placebo procedure involving sedation but no PCI. For the next 12 weeks, the patients reported anginal symptoms daily. At baseline, the patients' mean age was 64 years, 79% were male, 28% had diabetes mellitus, 80% had single-vessel disease, and most had moderate to severe angina (Canadian Cardiovascular Society class II or III). The median number of stents implanted was two in the PCI group. At 12 weeks, the mean daily number of angina episodes (0.3 vs. 0.7; odds ratio = 3.4; 95% CI, 2.0 to 5.9) and the angina symptoms score (2.9 vs. 5.6; P < .001) favored the PCI group. Masking was assessed to be effective.

Already a member/subscriber?  Log In


From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available

Issue Access

  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to

This series is coordinated by Natasha J. Pyzocha, DO, contributing editor.

A collection of POEMs published in AFP is available at

Continue Reading

More in AFP

More in PubMed

Copyright © 2024 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.