Percutaneous Coronary Intervention Versus Medical Treatment for Stable Angina Pectoris

  • STATUS
    Recruiting
  • End date
    Sep 30, 2022
  • participants needed
    450
  • sponsor
    Herlev and Gentofte Hospital
Updated on 25 January 2021
angiography
coronary artery disease
artery disease
medical therapy
heart disease
angina pectoris
percutaneous coronary intervention
stable angina
coronary disease
arterial disease
revascularisation

Summary

Patients with ischemic heart disease and symptoms due to lack of oxygen to the heart on exertion (stable angina pectoris) are usually treated by either percutaneous coronary intervention (PCI) or optimal medical therapy (OMT) alone. In patients with mild to moderate coronary artery disease the prognostic impact of PCI is probably limited. Furthermore it is unclear which treatment is superior in terms of relieving symptoms (PCI or OMT). In this trial, patients with mild to moderate coronary artery disease will be randomized to PCI or sham-PCI. All patients will undergo optimal medical therapy. It is hypothesized that PCI is superior to sham-PCI in patients with stable angina pectoris undergoing optimal medical therapy in terms of symptom-relief.

Description

Ischemic heart disease (IHD) is a major cause of death and disability worldwide. Patients with ischemic heart disease and symptoms due to lack of oxygen to the heart on exertion (stable angina pectoris) are usually treated by either percutaneous coronary intervention (PCI) or optimal medical therapy (OMT) alone. In patients with mild to moderate coronary artery disease the prognostic impact of PCI is probably limited. Furthermore it is unclear which treatment is superior in terms of relieving symptoms (PCI or OMT). Both treatments are effective in terms of reducing symptoms, but come with potential side effects.

PCI has in previous trials failed to show superiority compared to medical therapy in patients with stable angina pectoris. However, many visually significant lesions do not limit the blood flow significantly to the heart, and stenting such a lesion only exposes the patient to the risk of side effects of intervention. In recent years it has therefore become guideline-recommended practice to perform physiological test to evaluate a potential stenosis. During an angiography this is most often done using fractional flow reserve (FFR).

This study tests the optimal strategy for treatment of angina-symptoms in patients with stable pectoris. PCI is performed with modern stent designs and use of intravascular functional testing (FFR-guided PCI) and compared to sham-PCI.

Details
Condition Coronary Artery Disease, Coronary Artery Disease, Coronary heart disease, Vascular Diseases, Vascular Diseases, Heart disease, Heart disease, Cardiac Disease, Angina Pectoris, Angina, Ischemic Heart Disease, Cardiac Ischemia, Myocardial Ischemia, Stable Angina, Stable Angina Pectoris, Angina, Cardiac Ischemia, Myocardial Ischemia, Cardiac Disease, coronary disease, disease, coronary, coronary heart diseases
Treatment Percutaneous coronary intervention, Sham-percutaneous coronary intervention
Clinical Study IdentifierNCT04496648
SponsorHerlev and Gentofte Hospital
Last Modified on25 January 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Age 18-85 years
Patients with stable angina pectoris undergoing elective coronary angiography
Canadian Cardiovascular Society (CCS) class 2 or 3
Informed consent
Lesions in one or more coronary vessels with a diameter >2.5 mm with FFR-values 0.80, and suitable for complete revascularization with PCI

Exclusion Criteria

Contraindication to PCI or dual antiplatelet therapy (DAPT)
Use of or indication for oral anticoagulants (OAC) or novel oral anticoagulants (NOAC)
Use of clopidogrel
Life expectancy of less than 2 years
Severe valvular disease
Severe comorbidity
Acute coronary event within the past 12 months
Left ventricular ejection fraction 35%
Renal function with estimated glomerular filtration rate (eGFR) <30 mL/min
Pregnant or nursing
Severe coronary artery disease (left main stenosis, 3-vessel disease, proximal left anterior descending stenosis, chronic total occlusion of major vessel)
Coronary disease where complete revascularization by PCI is considered difficult or impossible
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