Evidence map›Paper›PMID 42100816›Full record

Trial reportCirculation2026

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

Fiyyaz Ahmed-Jushuf, Michael J Foley, Shayna Chotai, Christopher A Rajkumar, Danqi Wang, Florentina A Simader, Krzysztof Macierzanka, Kayla Chiew, Sannidhya Misra, Rupert Williams and 20 more

Abstract readRandomized Controlled TrialMulticenter Study
In one paragraph

Trial report in Circulation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

30 authors.

Fiyyaz Ahmed-JushufNational Heart and Lung Institute, Imperial College London, UK (F.A.-J., M.J.F., S.C., C.A.R., D.W., F.A.S., K.M., K.C., S.M., S.S.N., H.S., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.).ORCID 0000-0002-0650-6032
Michael J FoleyNational Heart and Lung Institute, Imperial College London, UK (F.A.-J., M.J.F., S.C., C.A.R., D.W., F.A.S., K.M., K.C., S.M., S.S.N., H.S., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.).ORCID 0000-0002-0330-5542
Shayna ChotaiNational Heart and Lung Institute, Imperial College London, UK (F.A.-J., M.J.F., S.C., C.A.R., D.W., F.A.S., K.M., K.C., S.M., S.S.N., H.S., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.).ORCID 0000-0002-6823-7309
Christopher A RajkumarNational Heart and Lung Institute, Imperial College London, UK (F.A.-J., M.J.F., S.C., C.A.R., D.W., F.A.S., K.M., K.C., S.M., S.S.N., H.S., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.).ORCID 0000-0002-0086-1113
Danqi WangNational Heart and Lung Institute, Imperial College London, UK (F.A.-J., M.J.F., S.C., C.A.R., D.W., F.A.S., K.M., K.C., S.M., S.S.N., H.S., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.).
Florentina A SimaderNational Heart and Lung Institute, Imperial College London, UK (F.A.-J., M.J.F., S.C., C.A.R., D.W., F.A.S., K.M., K.C., S.M., S.S.N., H.S., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.).
Krzysztof MacierzankaNational Heart and Lung Institute, Imperial College London, UK (F.A.-J., M.J.F., S.C., C.A.R., D.W., F.A.S., K.M., K.C., S.M., S.S.N., H.S., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.).ORCID 0009-0007-9021-4334
Kayla ChiewNational Heart and Lung Institute, Imperial College London, UK (F.A.-J., M.J.F., S.C., C.A.R., D.W., F.A.S., K.M., K.C., S.M., S.S.N., H.S., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.).ORCID 0000-0002-9694-2494
Sannidhya MisraNational Heart and Lung Institute, Imperial College London, UK (F.A.-J., M.J.F., S.C., C.A.R., D.W., F.A.S., K.M., K.C., S.M., S.S.N., H.S., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.).ORCID 0000-0002-5442-5659
Rupert WilliamsSt George's, University of London and St. George's University Hospitals NHS Foundation Trust, UK (R.W., J.C.S.).
Klio KonstantinouEssex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK (K.K., S.R.M., T.R.K., J.R.D., G.C., J.N.D.).
Jehangir N DinEssex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK (K.K., S.R.M., T.R.K., J.R.D., G.C., J.N.D.).
Shah R MohdnazriEssex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK (K.K., S.R.M., T.R.K., J.R.D., G.C., J.N.D.).ORCID 0000-0002-6055-5361
Peter D O'KaneUniversity Hospitals Dorset NHS Foundation Trust, Bournemouth, UK (J.N.D., P.D.O., J.H.).ORCID 0000-0001-5245-4547
Peter HaworthPortsmouth Hospitals University NHS Trust, UK (P.H.).ORCID 0009-0004-2762-0127
Sukhjinder S NijjerNational Heart and Lung Institute, Imperial College London, UK (F.A.-J., M.J.F., S.C., C.A.R., D.W., F.A.S., K.M., K.C., S.M., S.S.N., H.S., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.).ORCID 0000-0001-9146-1037
Henry SeligmanNational Heart and Lung Institute, Imperial College London, UK (F.A.-J., M.J.F., S.C., C.A.R., D.W., F.A.S., K.M., K.C., S.M., S.S.N., H.S., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.).ORCID 0000-0002-4244-860X
Thomas R KeebleEssex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK (K.K., S.R.M., T.R.K., J.R.D., G.C., J.N.D.).ORCID 0000-0001-8695-7994
John R DaviesEssex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK (K.K., S.R.M., T.R.K., J.R.D., G.C., J.N.D.).ORCID 0000-0003-2693-5114
Gerald CleshamEssex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK (K.K., S.R.M., T.R.K., J.R.D., G.C., J.N.D.).
Jonathan HintonUniversity Hospitals Dorset NHS Foundation Trust, Bournemouth, UK (J.N.D., P.D.O., J.H.).ORCID 0000-0003-1670-5550
James C SprattSt George's, University of London and St. George's University Hospitals NHS Foundation Trust, UK (R.W., J.C.S.).ORCID 0000-0001-8719-4538
Jason N DunguEssex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK (K.K., S.R.M., T.R.K., J.R.D., G.C., J.N.D.).ORCID 0000-0002-6086-6813
Daniel KnightRoyal Free London NHS Foundation Trust, UK (D.K., T.K.).
Tushar KotechaRoyal Free London NHS Foundation Trust, UK (D.K., T.K.).ORCID 0000-0003-0059-4817
Frank E HarrellVanderbilt University School of Medicine, Nashville, TN (F.E.H.).ORCID 0000-0002-8271-5493
James P HowardNational Heart and Lung Institute, Imperial College London, UK (F.A.-J., M.J.F., S.C., C.A.R., D.W., F.A.S., K.M., K.C., S.M., S.S.N., H.S., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.).ORCID 0000-0002-9989-6331
Darrel P FrancisNational Heart and Lung Institute, Imperial College London, UK (F.A.-J., M.J.F., S.C., C.A.R., D.W., F.A.S., K.M., K.C., S.M., S.S.N., H.S., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.).ORCID 0000-0002-3410-0814
Matthew J Shun-ShinNational Heart and Lung Institute, Imperial College London, UK (F.A.-J., M.J.F., S.C., C.A.R., D.W., F.A.S., K.M., K.C., S.M., S.S.N., H.S., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.).ORCID 0000-0002-1179-0867
Rasha K Al-LameeNational Heart and Lung Institute, Imperial College London, UK (F.A.-J., M.J.F., S.C., C.A.R., D.W., F.A.S., K.M., K.C., S.M., S.S.N., H.S., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.).ORCID 0000-0003-3752-5532

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn stable coronary artery disease, the primary goal of percutaneous coronary intervention (PCI) is symptom relief. Fractional flow reserve (FFR) and nonhyperemic pressure ratios such as resting full-cycle ratio (RFR) are used to guide revascularization. Although these indices correlate with myocardial ischemia, they have never been validated against the onset of angina. The physiological thresholds for angina, FFR

methodsORBITA-FIRE (Finding the Invasive Threshold for Symptom Relief in Exertional Angina) was a multicenter, double-blind, randomized, placebo-controlled study in patients with stable angina and single-vessel coronary artery disease. After imaging-guided PCI, an in-stent balloon was incrementally inflated until angina occurred at rest. This angina threshold was verified against placebo inflation, and corresponding FFR

resultsSixty-five patients were enrolled (mean age, 63.9±8.7 years; 74% male; 69% hypertensive; 23% diabetic; 91% with Canadian Cardiovascular Society class II-III angina). Median pre-PCI FFR was 0.59 (interquartile range [IQR], 0.46-0.70) and RFR was 0.61 (IQR, 0.40-0.82). Median FFR

conclusionsPhysiological thresholds for angina, FFR

Indexed as

Angina PectorisAngina, StableCoronary Artery DiseaseFractional Flow Reserve, MyocardialAgedDouble-Blind MethodFemaleHumansMaleMiddle AgedPercutaneous Coronary Interventionangina pectoriscontrolled clinical trials as topiccoronary artery diseasecoronary circulationfractional flow reserve, myocardialischemiapercutaneous coronary intervention

Identifiers

PMID42100816
PMCPMC13236056

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