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CMECNE

The ORBITA Trial: Are Stents Useful in Stable Angina?

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 instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

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 Dec 31 2017 through Dec 31 2021, 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 post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

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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The ORBITA Trial: Are Stents Useful in Stable Angina?