PCI eases angina symptoms in symptomatic single-vessel CTO

Undergoing percutaneous coronary intervention (PCI) results in improvements in angina symptoms beyond placebo in patients with symptomatic single-vessel coronary chronic total occlusion (CTO), according to a study.

Fifty patients were randomized to either CTO PCI (n=25) or placebo (n=25) between 19 October 2021 and 21 October 2025. One patient in the PCI group withdrew during the procedure due to a complication. All 50 patients were included in the primary analysis.

CTO PCI achieved an immediate and sustained improvement in the angina symptom score (odds ratio [OR], 4.38, 95 percent credible interval [Crl], 1.57‒12.69) relative to placebo, arising from a clear reduction in the number of angina episodes (OR, 4.38, 95 percent CrI, 1.55‒11.78). This led to an additional 30.6 days free of angina (95 percent Crl, 11.1‒50.7).

CTO PCI also improved the Seattle Angina Questionnaire in angina frequency (10.7, 95 percent Crl, 1.4‒20.2), physical limitation, quality of life, and summary score and Canadian Cardiovascular Society class.

“Blinding of patients, staff, and researchers was maintained,” the investigators said.

The multicentre, randomized controlled trial ORBITA-CTO involved patients with angina attributable to a single-vessel CTO, without bystander coronary disease. The ORBITA app was used to record angina symptoms daily.

The investigators randomized patients to CTO PCI or placebo following dual-injection coronary angiography, with repeat assessments at the 6-month follow-up. Antianginal medications were ceased at randomization and reintroduced on a patient-initiated protocol.