From ORBITA and ORBITA-2 to ARCA Registry. The coffin for PCI or the beginning of a new era in the treatment of non-acute myocardial ischemic syndromes?
The coffin for PCI or the beginning of a new era in the treatment of non-acute myocardial ischemic syndromes?
1 Outpatient Cardiology, ARCA (Associazioni Regionali Cardiologi Ambulatoriali), Pisa, Italy, Editor Cardiologia Ambulatoriale
2 Outpatient Cardiology, ARCA (Associazioni Regionali Cardiologi Ambulatoriali), Bari, Italy, Editor Cardiologia Ambulatoriale
3 Department of Cardiology, University of Pisa, Italy
4 Outpatient Cardiology, ARCA (Associazioni Regionali Cardiologi Ambulatoriali) National President, Pompei (NA), Italy
Abstract
During the years 2004 to 2020, six landmark trials (the Hambrecht study 1, the MASS-II trial 2-4, the COURAGE trial 5, 6, the BARI 2D trial 7, the FAME 2 trial 8, 9, the ISCHEMIA trial 10) and three meta-analyses (Katritsis, 2005 11; Stergiopoulos, 2014 12; Bangalore, 2020 13), compared coronary revascularization by means of coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) plus optimal medical therapy (OMT) with OMT alone in patients with non-acute myocardial ischemic syndromes (NAMIS). In none of these six trials nor in the three meta-analyses was the superiority of revascularization over medical therapy documented on the hard end-points of death and myocardial infarction, with the exception limited to CABG only in high-risk subgroups. These findings form a homogeneous body of evidence that is rare to be found in the literature. Moreover, the evidence supporting the positive prognostic impact of CABG in high-risk patients derives only from older studies performed in the 1980s, before the systematic use of the OMT 14.
Key words: ORBITA trial; ORBITA-2 trial; ARCA Registry; Stable angina; Non-acute myocardial ischemic syndromes.
