RITA 3 Trial: Interventional vs. Conservative Strategy in UA/NSTEMI

RITA 3 Trial Summary

Background:

  • Current guidelines recommend either an interventional strategy (angiography followed by revascularization) or a conservative strategy (ischemia-driven or symptom-driven angiography) for patients at moderate risk of death from unstable coronary artery disease.
  • The aim was to compare the effectiveness of an interventional strategy versus a conservative strategy in these patients.

Methods:

  • Randomized multicenter trial involving 1810 patients with non-ST-elevation acute coronary syndromes.
  • Mean age of patients was 62 years, with 38% women.
  • Patients were assigned to either an early intervention or conservative strategy.
  • Both groups received enoxaparin as the antithrombin agent.
  • Coprimary endpoints: combined rate of death, non-fatal myocardial infarction, or refractory angina at 4 months; and combined rate of death or non-fatal myocardial infarction at 1 year.
  • Analysis was conducted based on intention to treat.

Findings:

  • At 4 months, the intervention group had a lower incidence of death, myocardial infarction, or refractory angina compared to the conservative group (9.6% vs. 14.5%; risk ratio 0.66, 95% CI 0.51-0.85, p=0.001).
  • The difference was primarily due to a significant reduction in refractory angina in the intervention group.
  • There was no significant difference in the rates of death or myocardial infarction between the two groups at 1 year (7.6% vs. 8.3%; risk ratio 0.91, 95% CI 0.67-1.25, p=0.58).
  • The interventional strategy led to improved angina symptoms and reduced use of antianginal medications (p<0.0001).

Interpretation:

  • In patients with unstable coronary artery disease, an interventional strategy is preferred over a conservative strategy.
  • The interventional approach significantly reduces the incidence of refractory or severe angina without increasing the risk of death or myocardial infarction.
  • Patients benefit from improved angina symptoms and a decreased need for antianginal medications.

Key Takeaways:

  • The RITA 3 trial compared an interventional strategy to a conservative strategy in patients with unstable coronary artery disease.
  • Interventional strategy resulted in a lower incidence of death, myocardial infarction, or refractory angina at 4 months.
  • No significant difference in death or myocardial infarction rates between the two groups at 1 year.
  • The interventional strategy improved angina symptoms and reduced the use of antianginal medications.
  • These findings support the preference for an interventional approach in managing unstable coronary artery disease.

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