Medicine: Catheter intervention for stable angina is questionable

Sonntag, 20. Mai 2018 ab 13:30 Uhr (WH am Dienstag, 22. Mai ab 16 Uhr)

“PCI,” “Percutaneous coronary intervention,” is an intervention with a catheter for the treatment of severe hardening of the coronary arteries of the heart. A catheter is inserted. A balloon on the catheter is inflated at the hardened segments of the coronary arteries of the heart. In addition, a metallic stent can be placed at the hardened segments. Percutaneous coronary intervention is also known as PTCA, “Percutaneous transluminal coronary angioplasty.” Today, percutaneous coronary intervention is an integral part of modern cardiology.

Patients with “Stable angina” have no heart problems at rest but they do have heart problems under exertion. The heart problems are stress-induced; under emotional stress, physical exertion, during exposure to cold or after heavy meals. Stable angina with no heart symptoms at rest is different from unstable angina or myocardial infarction.

Does percutaneous coronary intervention help patients with stable angina? The clinical study “Orbita” from 2017 was a randomised, blinded, controlled clinical study. In 230 patients with stable angina and single-vessel-disease (hardening of 70% or more), first, drug treatment was optimised. Six weeks after this optimisation, the patients were randomised to two groups. The first group received a real percutaneous coronary intervention, and the second group received a sham intervention, i.e. a placebo intervention. The patients in both groups were documented heart patients. In both groups, they could withstand a stress test prior to the intervention on average only for 500 seconds. 6 weeks after the intervention respectively the sham intervention: After the real intervention, the patients could withstand the stress test 28 seconds longer. After the sham intervention, the patients could withstand the stress test 12 seconds longer. This difference, 16 seconds, is not significant. Also, the incidence of angina did not differ between the two groups. However, in the dobutamine echocardiography test, heart wall motion improved significantly after the real intervention. Therefore, seen overall, the benefit is there, but the benefit is small, not to say, too small.

A well-known professor draws the following conclusion: First, drug therapy should really be optimised in all patients with stable angina. Then, if this is still not enough, one can think about a percutaneous coronary intervention, but the expectations about the efficacy of this intervention should remain realistic, that is, one can expect only a low efficacy.

Dara Koper, News from the World of Medicine