Article Impact Level: HIGH Data Quality: STRONG Summary of New England Journal of Medicine, NEJMoa2310610. https://doi.org/10.1056/NEJMoa2310610 Dr. Christopher A. Rajkumar et al.
Points
- A study investigated whether percutaneous coronary intervention (PCI) provides greater relief from stable angina symptoms compared to a placebo procedure in patients not taking antianginal medication.
- The trial included 301 patients who underwent randomization, with 151 assigned to the PCI group and 150 to the placebo group.
- After a 12-week follow-up, the mean angina symptom score was significantly lower in the PCI group (2.9) compared to the placebo group (5.6).
- One patient in the placebo group experienced unacceptable angina leading to unblinding, while acute coronary syndromes occurred in 4 patients in the PCI group and six patients in the placebo group.
- The findings suggest that PCI can result in a lower angina symptom score and improved health status related to angina in patients with stable angina who are not receiving significant antianginal medication.
Summary
In a double-blind, randomized, placebo-controlled trial, researchers aimed to determine whether percutaneous coronary intervention (PCI) provides greater relief from stable angina symptoms compared to a placebo procedure in patients not receiving antianginal medication. Before randomization, patients underwent a 2-week symptom assessment phase after discontinuing all antianginal medications. The primary endpoint was the angina symptom score, calculated daily based on the number of angina episodes, prescribed antianginal medications, and clinical events. Higher scores indicated a worse health status related to angina.
A total of 301 patients were randomized, with 151 assigned to the PCI group and 150 to the placebo group. The majority were male (79%), with a mean age of 64±9 years. Ischemia was present in varying cardiac territories. The target vessels’ median fractional flow reserve and instantaneous wave-free ratio were 0.63 and 0.78, respectively. After a 12-week follow-up, the mean angina symptom score was significantly lower in the PCI group (2.9) compared to the placebo group (5.6) (odds ratio, 2.21; 95% confidence interval, 1.41 to 3.47; P<0.001). One patient in the placebo group experienced unacceptable angina leading to unblinding, while acute coronary syndromes occurred in 4 patients in the PCI group and six patients in the placebo group.
In patients with stable angina who were not receiving significant antianginal medication and had objective evidence of ischemia, PCI demonstrated a lower angina symptom score compared to a placebo procedure. This suggests an improved health status regarding angina symptoms. These findings highlight the potential benefits of PCI in reducing angina symptoms in this specific patient population.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24064
References Rajkumar, C. A., Foley, M. J., Ahmed-Jushuf, F., Nowbar, A. N., Simader, F. A., Davies, J. R., O’Kane, P. D., Haworth, P., Routledge, H., Kotecha, T., Gamma, R., Clesham, G., Williams, R., Din, J., Nijjer, S. S., Curzen, N., Ruparelia, N., Sinha, M., Dungu, J. N., … Al-Lamee, R. K. (2023). A Placebo-Controlled Trial of Percutaneous Coronary Intervention for Stable Angina. New England Journal of Medicine, NEJMoa2310610. https://doi.org/10.1056/NEJMoa2310610
