@article{Taylor:2026:10.1016/j.jcin.2026.01.305,
author = {Taylor, DJ and Yones, E and Newman, T and Gosling, R and Halliday, I and Xu, X and Saxton, H and Czechowicz, K and Narracott, A and Biancardi, AM and Hose, R and Shun-Shin, MJ and Gunn, JP and Al-Lamee, R and Morris, PD},
doi = {10.1016/j.jcin.2026.01.305},
journal = {JACC Cardiovasc Interv},
pages = {1259--1270},
title = {Coronary Microvascular Resistance as a Predictor of the Placebo-Controlled Response to Percutaneous Coronary Intervention: Microvascular-Stratified Analysis of ORBITA.},
url = {http://dx.doi.org/10.1016/j.jcin.2026.01.305},
volume = {19},
year = {2026}
}

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TY  - JOUR
AB  - BACKGROUND: The first placebo-controlled trial of percutaneous coronary intervention (PCI), ORBITA (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina; NCT02062593), showed minimal symptom benefit with PCI. No placebo-controlled data describing the relationship between microvascular resistance (MVR) and PCI exist. The authors hypothesized that patients with low MVR would derive the greatest benefit from PCI. OBJECTIVES: The aims of this study were to compute MVR in patients recruited for ORBITA and to evaluate interactions with prespecified endpoints. METHODS: Hyperemic MVR was calculated using computational fluid dynamics (CFD) and compared against placebo-controlled changes in treadmill exercise time, patient-reported symptoms, physician-assessed symptoms, and dobutamine stress echocardiography scores at 6-week follow-up. RESULTS: MVRCFD was computed for 131 patients (66 undergoing PCI and 65 placebo). Median MVRCFD was 1.38 mm Hg · min/mL (Q1-Q3: 0.89-2.09 mm Hg · min/mL). Baseline exercise time correlated with MVRCFD (ordinal correlation coefficient = 0.20; 95% credible interval [CrI]: 0.18-0.22). For patients with low (20th centile) MVRCFD, PCI increased exercise time by 48 seconds vs placebo (95% CrI: 6-92 seconds; Pr = 98.5%). Exercise time did not improve for patients with high (80th centile) MVRCFD (16 seconds; 95% CrI: -29 to 61 seconds; probability of significant difference [Pr] = 75.2%), but evidence for an interaction was modest (Printeraction = 83.1%). Low MVRCFD was also associated with a placebo-controlled benefit of PCI for likelihood of complete freedom from angina (Pr = 98.8%) and improvements in angina frequency (Pr = 97.8%) and stress echocardiography scores (Pr = 99.9%). CONCLUSIONS: The placebo-controlled benefit of PCI was greater in patients with lower MVRCFD, but interactions with symptom-based endpoints were modest. For patients with severe single-vessel disease taking opti
AU  - Taylor,DJ
AU  - Yones,E
AU  - Newman,T
AU  - Gosling,R
AU  - Halliday,I
AU  - Xu,X
AU  - Saxton,H
AU  - Czechowicz,K
AU  - Narracott,A
AU  - Biancardi,AM
AU  - Hose,R
AU  - Shun-Shin,MJ
AU  - Gunn,JP
AU  - Al-Lamee,R
AU  - Morris,PD
DO  - 10.1016/j.jcin.2026.01.305
EP  - 1270
PY  - 2026///
SP  - 1259
TI  - Coronary Microvascular Resistance as a Predictor of the Placebo-Controlled Response to Percutaneous Coronary Intervention: Microvascular-Stratified Analysis of ORBITA.
T2  - JACC Cardiovasc Interv
UR  - http://dx.doi.org/10.1016/j.jcin.2026.01.305
UR  - https://www.ncbi.nlm.nih.gov/pubmed/42043369
VL  - 19
ER  - 

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