A rigorous double-blind trial called ORBITA-FIRE found that the pressure ratios at which patients actually feel angina are far lower than the universal thresholds cardiologists use to decide who gets a stent. Researchers measured FFR and RFR values at the exact moment angina was triggered in stable coronary artery disease patients, at rest and during exercise. The angina thresholds were highly individual and consistently well below current clinical cutpoints. Patients with lower personal thresholds had heavier symptom burdens and gained more relief from PCI. This suggests that one-size-fits-all physiology scores may be leaving symptomatic patients undertreated, and that personalizing revascularization decisions to each patient's symptom-linked physiology could meaningfully improve outcomes.
