Science, Medicine, and the Anesthesiologist

The efficacy of percutaneous coronary interventions (PCIs) on symptom relief in patients with stable angina on little or no antianginal medications is uncertain. This double-blinded trial (14 United Kingdom sites) randomized 301 patients (mean ± SD age, 64 ± 9 yr; 79% male) with stable angina (in whom antianginal medications had been temporarily discontinued) to either PCI (N = 151) or a sham procedure (N = 150). Before randomization, subjects reported angina episodes using a smart phone app. After the procedure, subjects were discharged on dual antiplatelet therapy and followed for 12 weeks. The primary endpoint was the angina symptom score calculated on the number of angina episodes and the units of antianginal medication taken each day recorded on the smartphone app. Ischemia was present in one cardiac territory in 242 patients (80%), in two territories in 52 patients (17%), and in three territories in 7 patients (2%). At the 12-week follow-up, the mean angina symptom score was 2.9 in the PCI group and 5.6 in the sham group (odds ratio, 2.21; 95% CI, 1.41 to 3.47; P < 0.001). One sham patient was unblinded because of unacceptable angina. Acute coronary syndromes occurred in four PCI patients and in six sham procedure patients.

Take home message: In this double-blind randomized trial, PCI in patients with angina receiving little to no antianginal medication resulted in a significant reduction in a mean angina symptom score over 12 weeks relative to a sham procedure.