Blinded Trial Confirms PCI Reduces Angina in Chronic Total Occlusion

Carefully designed study shows significant improvement in symptoms for CTO patients treated with percutaneous intervention.

Mar. 30, 2026 at 5:37pm

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A small, tightly blinded clinical trial has confirmed that percutaneous coronary intervention (PCI) significantly reduces angina symptoms in patients with chronic total occlusion (CTO). The study, called ORBITA-CTO, found that PCI compared to a sham procedure led to an immediate and sustained reduction in angina, allowing antianginal medications to be reduced or eliminated.

Why it matters

This trial provides the first placebo-adjusted evidence that opening chronically occluded coronary arteries with PCI can translate into symptomatic improvement for patients. Despite previous studies showing PCI reduces angina in CTO, uncertainty about the value of the procedure has limited its use, with only 6-7% of CTO patients in the US currently undergoing PCI. This rigorous study design helps confirm the benefits of PCI for CTO patients.

The details

To eliminate confounding factors, the ORBITA-CTO trial enrolled only patients with single-vessel CTO, symptomatic angina, and a relatively simple CTO lesion (J-CTO score ≤ 3). After randomization, patients underwent a blinded procedure where both the PCI and sham groups had guide catheters placed, but only the PCI group received the intervention. All antianginal medications were stopped before the procedure. Patients then reported their angina symptoms daily using a smartphone app. The primary outcome was a composite of daily symptom burden, antianginal medication use, and override events like acute coronary syndrome. On this measure, the PCI group had 4.38 times the odds of improved angina scores over 24 weeks compared to controls. Patients in the PCI arm experienced 30.6 more angina-free days on average.

  • The ORBITA-CTO trial was presented at the American College of Cardiology (ACC) Scientific Session 2026.
  • The study was published simultaneously in the Journal of the American College of Cardiology.

The players

Sarosh Khan

MBBS, Department of Interventional Cardiology at Anglia Ruskin University School of Medicine in Essex, UK, and the presenter of the ORBITA-CTO trial results.

Ziad A. Ali

MD, DPhil, director of the DeMatteis Cardiovascular Institute at St Francis Hospital and Heart Center in Roslyn, New York, and the author of an accompanying editorial in the Journal of the American College of Cardiology.

J. Dawn Abbott

MD, director of the Interventional Cardiology Fellowship Training Program at Brown University in Providence, Rhode Island, and the ACC-invited discussant for the ORBITA-CTO trial.

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What they’re saying

“This resulted in 30.6 angina-free days in the PCI group relative to controls.”

— Sarosh Khan, Presenter of ORBITA-CTO trial results

“The between group differences emerged in follow-up immediately and the differences were sustained for the 24 weeks of follow-up.”

— Sarosh Khan, Presenter of ORBITA-CTO trial results

“Even though the angina relief was 'moderate rather than dramatic,' he praised the trial for finally providing evidence that 'the physiological act of reopening a chronically occluded coronary artery can translate into symptomatic improvement.'”

— Ziad A. Ali, Director, DeMatteis Cardiovascular Institute

What’s next

It is not clear that this study will be sufficient to change clinical guidelines, which currently provide a 2b recommendation for opening CTO lesions due to uncertain benefit. The next challenge for the field is to determine which CTO patients are most likely to benefit from PCI.

The takeaway

This carefully designed and blinded trial provides the first placebo-adjusted evidence that opening chronically occluded coronary arteries with PCI can lead to significant reductions in angina symptoms for patients. While the benefits were moderate rather than dramatic, this study helps confirm the value of PCI for CTO patients and may lead to increased use of the procedure.