{
    "abstract": "ORBITA-2 (the Placebo-Controlled Trial of Percutaneous Coronary Intervention for the Relief of Stable Angina) provided evidence for the role of percutaneous coronary intervention (PCI) for angina relief in stable coronary artery disease. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are often used to guide PCI; however, their ability to predict placebo-controlled angina improvement is unknown.\nParticipants with angina, ischemia, and stable coronary artery disease were enrolled, and anti-anginal medications were stopped. Participants reported angina episodes daily for 2 weeks using the ORBITA smartphone symptom application (ORBITA-app). At the research angiogram, FFR and iFR were measured. After sedation and auditory isolation, participants were randomized to PCI or placebo before entering a 12-week blinded follow-up phase with daily angina reporting. The ability of FFR and iFR, analyzed as continuous variables, to predict the placebo-controlled effect of PCI was tested using Bayesian proportional odds modeling.\nInvasive physiology data were available for 279 patients (140 PCI and 139 placebo). The median (interquartile range) age was 65 years (59.0-70.5), and 223 (79.9%) were male. Median FFR was 0.60 (0.46-0.73), and median iFR was 0.76 (0.50-0.86). The lower the FFR or iFR, the greater the placebo-controlled improvement with PCI across all end points. There was strong evidence that a patient with an FFR at the lower quartile would have a greater placebo-controlled improvement in angina symptom score with PCI than a patient at the upper quartile (FFR, 0.46 versus 0.73: odds ratio, 2.01; 95% credible interval, 1.79-2.26; probability of interaction, >99.9%). Similarly, there was strong evidence that a patient with an iFR at the lower quartile would have greater placebo-controlled improvement in angina symptom score with PCI than a patient with an iFR at the upper quartile (iFR, 0.50 versus 0.86: odds ratio, 2.13; 95% credible interval, 1.87-2.45; probability of interaction, >99.9%). The relationship between benefit and physiology was seen in both Rose angina and Rose nonangina.\nPhysiological stenosis severity, as measured by FFR and iFR, predicts placebo-controlled angina relief from PCI. Invasive coronary physiology can be used to target PCI to those patients who are most likely to experience benefit.\nURL: https://www.clinicaltrials.gov; Unique identifier: NCT03742050.",
    "authors": [
        {
            "affiliation": "National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., K.M., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).\nDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).",
            "firstname": "Michael J",
            "initials": "MJ",
            "lastname": "Foley"
        },
        {
            "affiliation": "National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., K.M., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).\nDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).",
            "firstname": "Christopher A",
            "initials": "CA",
            "lastname": "Rajkumar"
        },
        {
            "affiliation": "National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., K.M., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).\nDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).",
            "firstname": "Fiyyaz",
            "initials": "F",
            "lastname": "Ahmed-Jushuf"
        },
        {
            "affiliation": "National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., K.M., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).\nDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).",
            "firstname": "Florentina",
            "initials": "F",
            "lastname": "Simader"
        },
        {
            "affiliation": "National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., K.M., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).\nDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).",
            "firstname": "Shayna",
            "initials": "S",
            "lastname": "Chotai"
        },
        {
            "affiliation": "National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., K.M., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).\nDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).",
            "firstname": "Henry",
            "initials": "H",
            "lastname": "Seligman"
        },
        {
            "affiliation": "National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., K.M., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).",
            "firstname": "Krzysztof",
            "initials": "K",
            "lastname": "Macierzanka"
        },
        {
            "affiliation": "Department of Cardiology, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, United Kingdom (J.R.D., T.R.K., G.C.).\nMedical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, United Kingdom (J.R.D., T.R.K.).",
            "firstname": "John R",
            "initials": "JR",
            "lastname": "Davies"
        },
        {
            "affiliation": "Department of Cardiology, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, United Kingdom (J.R.D., T.R.K., G.C.).\nMedical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, United Kingdom (J.R.D., T.R.K.).",
            "firstname": "Thomas R",
            "initials": "TR",
            "lastname": "Keeble"
        },
        {
            "affiliation": "Department of Cardiology, University Hospitals of Dorset NHS Foundation Trust, Bournemouth, United Kingdom (P.O., J.D.).",
            "firstname": "Peter",
            "initials": "P",
            "lastname": "O'Kane"
        },
        {
            "affiliation": "Department of Cardiology, Portsmouth Hospitals University NHS Trust, United Kingdom (P.H.).",
            "firstname": "Peter",
            "initials": "P",
            "lastname": "Haworth"
        },
        {
            "affiliation": "Department of Cardiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.R.).",
            "firstname": "Helen",
            "initials": "H",
            "lastname": "Routledge"
        },
        {
            "affiliation": "Department of Cardiology, Royal Free London NHS Foundation Trust, United Kingdom (T.K.).",
            "firstname": "Tushar",
            "initials": "T",
            "lastname": "Kotecha"
        },
        {
            "affiliation": "Department of Cardiology, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, United Kingdom (J.R.D., T.R.K., G.C.).",
            "firstname": "Gerald",
            "initials": "G",
            "lastname": "Clesham"
        },
        {
            "affiliation": "Department of Cardiology, St George's University of London, United Kingdom (R.W., J.S.).",
            "firstname": "Rupert",
            "initials": "R",
            "lastname": "Williams"
        },
        {
            "affiliation": "Department of Cardiology, University Hospitals of Dorset NHS Foundation Trust, Bournemouth, United Kingdom (P.O., J.D.).",
            "firstname": "Jehangir",
            "initials": "J",
            "lastname": "Din"
        },
        {
            "affiliation": "National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., K.M., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).\nDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).",
            "firstname": "Sukhjinder S",
            "initials": "SS",
            "lastname": "Nijjer"
        },
        {
            "affiliation": "Department of Cardiology, University of Southampton School of Medicine & University Hospital Southampton NHS Foundation Trust, United Kingdom (N.C.).",
            "firstname": "Nick",
            "initials": "N",
            "lastname": "Curzen"
        },
        {
            "affiliation": "Department of Cardiology, Salisbury Hospital NHS Foundation Trust, United Kingdom (M.S.).",
            "firstname": "Manas",
            "initials": "M",
            "lastname": "Sinha"
        },
        {
            "affiliation": "National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., K.M., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).\nDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).\nDepartment of Cardiology, Buckinghamshire Healthcare NHS Trust, High Wycombe, United Kingdom (R.P.).",
            "firstname": "Ricardo",
            "initials": "R",
            "lastname": "Petraco"
        },
        {
            "affiliation": "Department of Cardiology, St George's University of London, United Kingdom (R.W., J.S.).",
            "firstname": "James",
            "initials": "J",
            "lastname": "Spratt"
        },
        {
            "affiliation": "National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., K.M., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).\nDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).",
            "firstname": "Sayan",
            "initials": "S",
            "lastname": "Sen"
        },
        {
            "affiliation": "National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., K.M., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).\nDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).",
            "firstname": "Graham D",
            "initials": "GD",
            "lastname": "Cole"
        },
        {
            "affiliation": "Department of Biostatistics, Vanderbilt University Medical Centre, Nashville, TN (F.E.H.).",
            "firstname": "Frank E",
            "initials": "FE",
            "lastname": "Harrell"
        },
        {
            "affiliation": "National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., K.M., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).\nDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).",
            "firstname": "James P",
            "initials": "JP",
            "lastname": "Howard"
        },
        {
            "affiliation": "National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., K.M., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).\nDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).",
            "firstname": "Darrel P",
            "initials": "DP",
            "lastname": "Francis"
        },
        {
            "affiliation": "National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., K.M., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).\nDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).",
            "firstname": "Matthew J",
            "initials": "MJ",
            "lastname": "Shun-Shin"
        },
        {
            "affiliation": "National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., K.M., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).\nDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom (M.J.F., C.A.R., F.A.-J., F.S., S.C., H.S., S.S.N., R.P., S.S., G.D.C., J.P.H., D.P.F., M.J.S.-S., R.A.-L.).",
            "firstname": "Rasha",
            "initials": "R",
            "lastname": "Al-Lamee"
        },
        {
            "affiliation": null,
            "firstname": null,
            "initials": null,
            "lastname": null
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.1161/CIRCULATIONAHA.124.072281",
    "journal": "Circulation",
    "keywords": [
        "angina, stable",
        "cardiovascular physiology",
        "clinical trials, randomized",
        "coronary artery disease",
        "ischemia, myocardial"
    ],
    "methods": null,
    "publication_date": "2024-10-27",
    "pubmed_id": "39462291\n29103656\n32207889\n37471501\n31504439\n29789302\n31707827\n20557963\n22779086\n7860905\n18672159\n38015442\n38759906\n37245131\n39210710\n35156616\n36382002\n20557846\n12093768\n28833869\n13974778\n30354650\n33496201\n8637515",
    "results": "Invasive physiology data were available for 279 patients (140 PCI and 139 placebo). The median (interquartile range) age was 65 years (59.0-70.5), and 223 (79.9%) were male. Median FFR was 0.60 (0.46-0.73), and median iFR was 0.76 (0.50-0.86). The lower the FFR or iFR, the greater the placebo-controlled improvement with PCI across all end points. There was strong evidence that a patient with an FFR at the lower quartile would have a greater placebo-controlled improvement in angina symptom score with PCI than a patient at the upper quartile (FFR, 0.46 versus 0.73: odds ratio, 2.01; 95% credible interval, 1.79-2.26; probability of interaction, >99.9%). Similarly, there was strong evidence that a patient with an iFR at the lower quartile would have greater placebo-controlled improvement in angina symptom score with PCI than a patient with an iFR at the upper quartile (iFR, 0.50 versus 0.86: odds ratio, 2.13; 95% credible interval, 1.87-2.45; probability of interaction, >99.9%). The relationship between benefit and physiology was seen in both Rose angina and Rose nonangina.",
    "title": "Fractional Flow Reserve and Instantaneous Wave-Free Ratio as Predictors of the Placebo-Controlled Response to Percutaneous Coronary Intervention in Stable Coronary Artery Disease.",
    "xml": "<Element 'PubmedArticle' at 0x78850371b2e0>"
}