Coronary stenting does relieve angina after all - but in the right people.
The original ORBITA trial (https://sci-hub.se/10.1016/S0140-6736(17)32714-9) tested whether the guideline recommendation for coronary stenting only as an add-on to anti-anginal therapy, gave effective angina relief. It surprised the cardiology world by showing no significant angina relief, against meticulous placebo control.
5 years later, the 2023 ORBITA-2 (doi: 10.1056/NEJMoa2310610) solved this mystery. The error was in the guidelines that restricted stenting to patients in whom anti-anginals had not been effective. This will turn our practice on its head, by giving patients an intelligent and scientifically valid choice in how to manage their angina.
And finally, in 2024, we are learning which patients gain the most angina relief from stenting: the answer turns out to be in the exquisite detail of the symptoms! William Osler would have been proud.
Professor Darrel Francis
Consultant Cardiologist, The Frater Clinic
Clinical Head of Cardiovascular Division, National Heart and Lung Institute
