What question did this study set out to answer?

The study aims to identify individualized physiological thresholds for angina during exercise assessments.

May 9, 2026Open Access

Determining the Physiological Threshold for Angina (ORBITA-FIRE): A Double-Blind, Randomized, Placebo-Controlled Study

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Angina. Intervention: Physiological threshold assessment vs. Placebo. Primary outcome: Angina thresholds at symptom onset (p=>0.999).

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Published in Circulation, the ORBITA-FIRE study challenges the universal ischemic thresholds used to guide PCI by demonstrating that the physiological thresholds for angina are highly individualized and vary with cardiac workload. This is sparking intense debate about personalizing revascularization strategies.

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Key Result

Physiological thresholds for angina are highly individualized, vary with cardiac workload, and are consistently lower than universal ischemia-based thresholds (P>0.999).

Key Points

The study aims to identify individualized physiological thresholds for angina during exercise assessments.
Double-blind, randomized, placebo-controlled design
Recorded angina values at symptom onset during low- and high-intensity exercise
Evaluated changes in thresholds with increasing cardiac workload
Angina thresholds were consistently lower than universal ischemia-based thresholds
Thresholds varied significantly with different cardiac workloads
Findings support the need for personalized approaches in patient selection for PCI

Study Design

Type

RCT

Randomization

Randomized

Blinding

Double-Blind

PICO

Population

Angina

Intervention / Comparator

Physiological threshold assessment vs Placebo

Primary Outcome

Angina thresholds at symptom onset, p=>0.999

Main Result

p-value: p=>0.999

Abstract

BACKGROUND: ) at rest and during exercise remain undefined. METHODS: values were recorded at symptom onset. The protocol was repeated during low- and high-intensity exercise to assess changes in angina thresholds with increasing cardiac workload. RESULTS: >0.999). CONCLUSIONS: ) are highly individualized, vary with cardiac workload, and are consistently lower than the universal ischemia-based thresholds used to guide revascularization. These findings support integrating personalized, symptom-linked physiology to refine patient selection and to improve symptomatic response to PCI.

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Authors

Fiyyaz Ahmed-Jushuf

Imperial College Healthcare NHS Trust

Michael J. Foley

Imperial College Healthcare NHS Trust

Shayna Chotai

Imperial College Healthcare NHS Trust

Journals

Circulation

Actions

Institutions

University College London

Vanderbilt University

Lung Institute

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Determining the Physiological Threshold for Angina (ORBITA-FIRE): A Double-Blind, Randomized, Placebo-Controlled Study

Key Result

Key Points

Study Design

PICO

Main Result

Abstract

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Discussion

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