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Grand Rounds
CMECNE

The ORBITA Trial: Are Stents Useful in Stable Angina?  

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Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. State current strategies for the management of stable angina
2. Discuss the findings of the study by Al-Lamee et al., when comparing PCI to placebo in patients with stable angina

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.

The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 1/31/2017 through 1/25/2023, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the test and evaluation. Upon registering and successfully completing the test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

BACKGROUND AND PURPOSE:

  • Previous studies demonstrated that percutaneous coronary intervention (PCI), when used for stable angina, did not reduce myocardial infarctions and death rates
  • First-line therapy for angina relief is antianginal medication followed by PCI if patients are still symptomatic
    • Medications have been found to increase treadmill exercise time by 48–55 s compared to placebo
  • There is no RCT evidence that PCI works to relieve symptoms in stable angina
  • Al-Lamee et al. (Lancet, 2017) sought to determine if PCI if efficacious for symptomatic relief in stable angina

METHODS:

  • Multicenter, blinded RCT done in the UK
  • Inclusion criteria
    • 18−85 years with angina and ≥ 1 angiographically significant lesion (≥70%) in a single vessel that was clinically appropriate for PCI
  • Phase 1 of the study – ALL patients
    • 6-week medical optimization with appropriate antianginal therapy
    • All patients were pretreated with dual antiplatelet therapy
  • Phase 2 of the study – Randomized blinded period
    • Patients randomized to undergo PCI or the placebo procedure
    • PCI procedure: All PCI was done with drug-eluting stents
    • Placebo procedure: Patients kept sedated for at least 15 min on the catheter laboratory table and catheters were withdrawn
  • Primary outcome: Difference in exercise time increment between the groups

RESULTS:

  • 200 patients underwent randomization
    • 105 patients in PCI group and 95 in the placebo procedure
  • There was no significant difference in exercise time increment (PCI minus placebo 16.6 s, 95% CI –8.9 to 42.0, p=0.200)
  • Symptoms: During phase 2, there were no significant differences between groups in
    • Seattle physical limitation score (2.4, 95% CI –3.5 to 8.3, p=0.420)
    • Seattle angina frequency (4.4, –3.3 to 12.0, p=0.260)
    • Seattle angina stability score (0.9, –8.4 to 10.2, p=0.851)

CONCLUSION:

  • The authors state that in the setting of medically treated stable angina and severe coronary stenosis, PCI did not improve exercise capacity or symptoms compared to placebo
  • Benefits seen with stent placement may have a large placebo component
  • Efficacy of invasive procedures can be studied with more rigor, similar to pharmacotherapy

Learn More – Primary Sources:

Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial (Lancet, 2017)

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Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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