Study Explores PCI Benefits for Older Adults

ORBITA-2 trial data emphasize that age alone should not determine if patients undergo symptom-relieving therapies.

Jan. 30, 2026 at 7:31am

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A secondary analysis of the ORBITA-2 randomized, placebo-controlled trial found that while there was a modest link between age and severity of symptoms and stenosis, percutaneous coronary intervention (PCI) was more effective in relieving symptoms in older patients than in younger ones. However, the impact of PCI on treadmill time was significantly greater in younger patients. Experts say several factors beyond just age can modify the benefit of PCI for older adults, and shared decision-making is crucial to align treatment with the patient's values and overall health.

Why it matters

The findings challenge the notion that age should be the sole deciding factor for whether older adults undergo PCI to treat stable angina. The study highlights the need to consider a range of individual factors beyond just age when determining the appropriate treatment approach.

The details

The ORBITA-2 trial was the first randomized, placebo-controlled study to demonstrate the efficacy of PCI for symptom relief in patients with stable angina and coronary artery disease without background antianginal medication. This secondary analysis examined the relationship between age and the severity of symptoms and stenosis in older patients. In a cohort of 301 patients with an average age of 64, researchers found that PCI was more effective in relieving symptoms in older patients than in younger ones, but its impact on treadmill time was greater in younger patients. Experts say factors like osteoarthritis, multiple chronic conditions, diffuse and heavily calcified coronary disease, and the need for long-term antiplatelet therapy can all modify the benefits of PCI in older adults.

  • The ORBITA-2 trial was published on January 30, 2026.

The players

Rasha K. Al-Lamee, MD

Researcher at the National Heart and Lung Institute at Imperial College London, Hammersmith Hospital Campus, London, England.

Michael G. Nanna, MD, MHS

Researcher from the Section of Cardiovascular Medicine at Yale School of Medicine in New Haven, Connecticut.

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What they’re saying

“Given that the primary analysis showed that the PCI's effect was greatest with little or no prior antianginal therapy, we wanted to see if we could target upfront PCI for patients who would stand to benefit the most. We explored whether age was a key factor in decision-making and if antianginal medication therapy should be considered prior to PCI for older individuals. The study team also investigated if it was prudent to offer PCI strictly to patients who remained symptomatic.”

— Rasha K. Al-Lamee, MD, Researcher

“Coronary disease in this population is often diffuse and heavily calcified, which can limit the durability of PCI results. In addition, symptoms such as shortness of breath or fatigue may be related to microvascular disease, diastolic dysfunction, or deconditioning rather than a focal blockage. This means that opening a single artery may not lead to meaningful improvement.”

— Michael G. Nanna, MD, MHS, Researcher

What’s next

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The takeaway

This study highlights the need to move beyond age as the sole factor in determining if older adults should undergo PCI for stable angina. A range of individual characteristics, including overall health status and the nature of the coronary disease, must be carefully considered to ensure the treatment approach aligns with the patient's values and anticipated benefits.