Study of Lesion-Specific Invasive Haemodynamic Angina Thresholds
Imperial College London
60 participants
Feb 10, 2026
INTERVENTIONAL
Summary
ORBITA-SOLAR is an invasive physiological cardiac catheterisation study that aims to determine whether different coronary stenoses have different angina thresholds. The angina threshold is defined as the amount of coronary flow reduction required to reproduce symptoms. Sixty patients with symptoms of stable angina and 2 coronary artery stenoses amenable to percutaneous coronary intervention (PCI) will be recruited. This study will use intra-coronary balloon inflation during supine exercise on an ergometer to measure the fractional flow reserve (FFR) and non-hyperemic pressure ratio (NHPR) that relates to angina onset, in real time, at the location of each stenosis.
Eligibility
Inclusion Criteria10
- Eligibility for PCI due to angina or angina-equivalent symptoms on exertion
- 2 severe epicardial stenoses in a major coronary artery, defined as:
- ≥70% stenosis in a coronary artery with ≥2.5mm diameter, on invasive coronary angiography (ICA)
- Severe stenosis in a vessel with ≥2.5mm diameter, on CTCA
- Evidence of ischaemia on an invasive or non-invasive test, including:
- Physiological test during invasive coronary angiography (ICA)
- Dobutamine stress echocardiography (DSE)
- Stress perfusion cardiac magnetic resonance (CMR)
- Myocardial perfusion scintigraphy (MPS)
- Fractional flow reserve computed-tomography (FFR-CT)
Exclusion Criteria15
- Age <18 years
- Acute coronary syndrome within 3 months
- Previous coronary artery bypass graft
- Significant left main stem disease
- Single lesion amenable to PCI
- Chronic total occlusion of the target artery
- Moderate to severe valve disease
- LVEF ≤40%, contraindication to PCI or drug-eluting stents
- PCI performed with drug-eluting balloons without stenting
- Contraindication to antiplatelet therapy
- Contraindication to adenosine
- Physical inability to exercise with an ergometer
- Femoral artery access
- Pregnancy
- Inability to consent
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Interventions
Clinically indicated PCI for the management of stable angina
Following stenting, the order in which to perform the angina threshold assessment at the location of each stent will be randomised. A non-compliant balloon with gradually be inflated over a pressure wire within the deployed stent to re-introduce stenosis. Simultaneously, the participant will exercise on a supine ergometer. At the point when angina is reproduced, the patient will rest and further balloon inflation will stop. Physiological measurements using the pressure wire will be taken with the inflated balloon in situ. This will represent the invasive physiological angina threshold. The balloon will then be deflated and removed. These steps will be repeated at the location of the second stent.
Locations(6)
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NCT07386418