American College of Cardiology Congress 2026 - Dr Sarosh Khan and Dr John Davies (Essex Cardiothoracic Centre, Basildon, UK) join us to discuss results from the ORBITA-CTO trial (NCT05142215; Mid and South Essex NHS Foundation Trust), a randomised, placebo-controlled study evaluating CTO PCI versus placebo for the relief of stable angina.

This double-blind, randomised, placebo-controlled pilot trial enrolled 50 patients with stable angina attributable to a single-vessel CTO, confirmed ischaemia in the CTO territory, and background optimal medical therapy. Patients were randomised to CTO PCI using contemporary techniques and drug-eluting stents, or a placebo procedure, with both groups remaining blinded throughout. The primary endpoint was change in angina symptom ordinal scale score at 24 and 26 weeks, with secondary endpoints including Seattle Angina Questionnaire domains, quality of life, dyspnoea, and exercise capacity measured by peak VO₂.

Findings were highly statistically significant, patients in the CTO angioplasty group were four times as likely to have improved angina scores as compared to the placebo group. Compared to placebo, patients in the intervention group also had a statistically significant improvement in quality-of-life scores, and reduced angina severity as assessed by physicians. 

Interview Questions:

1. What was the evidence gap that ORBITA-CTO was designed to address?
2. Can you walk us through the trial design and the particular challenges of blinding patients and investigators in a procedural intervention of this complexity?
3. What did the primary endpoint reveal about the impact of CTO PCI on angina symptom burden?
4. How did secondary measures of quality of life and exercise capacity compare between groups?
5. How do these findings relate to the broader ORBITA programme and what do they tell us about the true symptomatic benefit of revascularisation beyond the placebo effect?
6. What are your key take-home messages for interventional cardiologists considering CTO PCI for their patients and what should a definitive larger trial look like?

Recorded on-site at ACC 2026, New Orleans.

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Editor: Jordan Rance
Videographer: Mike Knight, David Ben-Harosh
Support: This is an independent interview produced by Radcliffe Cardiology.