Interventional versus conservative treatment in acute non-ST elevation coronary syndrome: time course of patient management and disease events over one year in the RITA 3 trial.

Heart
P A Poole-WilsonRandomised Intervention Trial of unstable Angina Investigators

Abstract

To determine whether, in acute non-ST elevation coronary syndrome, the benefit from early invasive coronary intervention compared with a conservative strategy of later symptom-guided intervention varies over time. In RITA 3 (Randomised Intervention Trial of unstable Angina 3) patients were randomly assigned to coronary angiography (median 2 days after randomisation) and appropriate intervention (n = 895) or to a symptom-guided conservative strategy (n = 915). In the first week patients in both groups were at highest risk of death, myocardial infarction (MI) or refractory angina (incidence rate 40 times higher than in months 5-12 of follow up). There were 22 MIs and 6 deaths in the intervention group (largely due to procedure-related events, 14 MIs and 3 deaths) versus 17 MIs and 3 deaths in the conservative group. In the rest of the year there were an additional 12 versus 27 MIs, respectively (treatment-time interaction p = 0.021). Over one year in the intervention group there was a 43% reduction in refractory angina; 22% of patients underwent coronary artery bypass surgery and 35% underwent percutaneous coronary intervention only, which reduced refractory angina but provoked some early MIs; and 43% were still treated medically...Continue Reading

References

Dec 8, 2000·Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology·M Galli
Jun 23, 2001·The New England Journal of Medicine·C P CannonUNKNOWN TACTICS (Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy)--Thrombolysis
Oct 29, 2003·Archives of Internal Medicine·Christopher B GrangerUNKNOWN Global Registry of Acute Coronary Events Investigators
Jan 25, 2005·BMJ : British Medical Journal·Frans Van de WerfUNKNOWN GRACE Investigators
Jun 16, 2005·JAMA : the Journal of the American Medical Association·Shamir R MehtaSalim Yusuf
Sep 16, 2005·The New England Journal of Medicine·Robbert J de WinterUNKNOWN Invasive versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) Investigators

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Citations

Nov 2, 2011·Journal of Cardiovascular Translational Research·Peter R Sinnaeve
Apr 21, 2010·Nature Reviews. Cardiology·Oussama Wazni, Bruce L Wilkoff
Feb 22, 2013·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Damian J KellyAnthony H Gershlick
Nov 11, 2008·Scandinavian Cardiovascular Journal : SCJ·Ville HällbergUNKNOWN Working after CABG study group
Aug 18, 2016·European Heart Journal. Cardiovascular Pharmacotherapy·Leonardo De LucaUNKNOWN EYESHOT Investigators
Jun 23, 2009·Journal of Clinical Nursing·John X RolleyCheryl R Dennison
Nov 23, 2013·The American Journal of Medicine·Dhaval KolteWilbert S Aronow
Aug 30, 2020·European Heart Journal·Jean-Philippe ColletUNKNOWN ESC Scientific Document Group

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