Re: Five-year results from RITA-3 indicate less MI/death in patients treated with an early interventional strategy
- From: William Wagner <PainInAss__williamwag@xxxxxxxxx>
- Date: Thu, 08 Sep 2005 16:35:18 -0400
In article <GY%Te.1433$mj1.1046@xxxxxxxxxxxxxxxxxxxxxxxxxx>,
"Bill" <xxx@xxxxx> wrote:
> Five-year results from RITA-3 indicate less MI/death in patients treated with
> an early interventional strategy
>
> Sep 7, 2005 Shelley Wood
>
>
>
>
>
>
> Stockholm, Sweden - A routine invasive strategy leads to a reduction in risk
> of death/MI and cardiac deaths over the long term, five-year results from the
> RITA-3 trial show. Dr Keith Fox (Royal Infirmary of Edinburgh, UK),
> presenting
> the results here at the European Society of Cardiology Congress 2005,
> emphasized that the major benefit of an early invasive strategy is seen in
> patients with a higher baseline risk.
>
>
>
>
>
>
>
> "A strategy of routine angiography and intervention is appropriate for all
> moderate- and high-risk patients with non-ST-elevation ACS," Fox stated. "A
> systematic analysis of baseline risk is required to ID those with the largest
> potential for benefit."
>
> The RITA-3 long-term results are published simultaneously online today in the
> Lancet [1].
>
> RITA-3 randomized 1810 patients from 45 hospitals in England and Scotland
> with
> non-ST-elevation ACS to either an early intervention or a conservative
> strategy of ischemia-driven or symptom-driven angiography. As previously
> reported by heartwire, one-year RITA-3 results showed no differences in rates
> of death or nonfatal MI between the two groups but half the recurrence rate
> of
> refractory angina in the early-intervention group. As Fox reported today, at
> five-year follow-up, patients randomized to initial interventional treatment
> had a reduced risk of dying or having an MI, with the curves diverging after
> the first year.
>
> The most common predictors of death or MI were age, diabetes mellitus,
> previous MI, and current smoking, but even after adjustment for these
> factors,
> the reduced risk of death/MI in the interventional group remained
> significant.
> When patients were examined according to degree of baseline risk, Fox et al
> report that patients at low risk derived almost no benefit from an invasive
> strategy compared with a conservative strategy, but patients in the
> highest-risk category were overwhelmingly more likely to die or have a repeat
> MI if randomized to conservative management.
>
> "The early hazards of a routine interventional strategy are outweighed by
> more
> events in the conservative group over time," Fox et al report.
>
> Five-year outcomes in RITA-3
>
>
> End point
> Interventional (n=895), n (%)
> Conservative (n=915), n (%)
> Odds ratio (95% CI)
> p
>
> Death/MI
> 142 (16.6)
> 178 (20.0)
> 0.78 (0.61-0.99)
> 0.044
>
> Death
> 102 (12.1)
> 132 (15.1)
> 0.76 (0.58-1.00)
> 0.054
>
> Non-CV death
> 40
> 42
> -
> NS
>
> CV death
> 62
> 90
> 0.68 (0.49-0.95)
> 0.026
>
> CV death/MI
> 105 (12.2)
> 139 (15.9)
> 0.74 (0.56-0.97)
> 0.030
>
>
>
>
> To download table as a slide, click on slide logo below
>
> Discussing the results following the presentation today, Dr Freek Verheugt
> (University Medical Center, Nijmegen, the Netherlands) congratulated the
> RITA-3 investigators for conducting what is now the largest and longest
> follow-up of an invasive/conservative management trial. After all, Verheugt
> quipped, quoting a 1982 comment from colleague Dr Thijs Plokker: "Performing
> PCI is like having sex. Everyone likes to do it, but nobody cares about the
> late results."
>
>
>
> Performing PCI is like having sex. Everyone likes to do it, but
> nobody cares about the late results.
>
>
>
>
>
>
>
>
>
>
> While RITA-3 provides important new information on the long-term benefits of
> an early interventional strategy on the combination of reinfarction and
> death,
> Verheugt said, it does not resolve the question of overall mortality and
> specifically whether the risks of performing an intervention in unstable,
> high-risk patients is offset by the benefits over time. In the only two
> studies to look exclusively at patients with positive troponin levelsICTUS
> and
> VANQWISHpatients randomized to the invasive strategy were more likely to die
> over the follow-up period, Verheugt noted.
>
> As Verheugt explained to heartwire, an early invasive strategy may lead to
> less reinfarction, but it does not consistently lead to fewer deaths, namely
> because of the high risks associated with performing interventions in
> patients
> with troponin levels five times the upper limit of normal or greater.
>
> "Given the so-far negative results in the trials with high-risk patients
> only,
> large prospective trials in high-risk patients are necessary," Verheugt said.
>
> In an interview with heartwire, Fox clarified that only 10% of the RITA-3
> population had no elevation of cardiac troponin or enzyme markersdata he did
> not show during his presentation. "In fact, 90% of the population was
> positive, and you can't say that this wasn't a population that included a
> spectrum of riskup to 50% of the patients in the highest eighth of risk had
> death/MI in the conservative arm at five years, despite a high level of
> secondary-prevention therapy," Fox said. "So I don't accept the argument that
> this is a purely lower-risk population."
>
> Fox added that while deaths from cancer and accidents tend to have an effect
> on the randomized treatment effect over time, there were no differences in
> noncardiac deaths in the RITA-3 five-year follow-up. "If you look at
> cardiovascular deaths, the p value was 0.03, there was a 32% reduction in
> cardiovascular deaths. So I would disagree, I think we do have robust
> information on CV death."
>
>
>
>
>
>
>
> Source
>
>
> 1.. Fox KAA, Poole-Wilson P, Clayton TC et al. Five-year
> outcome
> of an interventional strategy in non-ST-elevation acute coronary syndrome:
> the
> British Heart Foundation RITA-3 randomised trial. Lancet 2005; 366:914-920.
>
>
>
>
>
>
> Related links
>
>
> To cath or not to cath? Early invasive strategy for unstable
> angina debated anew
> [HeartWire > News; Aug 13, 2003]
>
> RITA-3: Aggressive intervention for non-ST-elevation MI
> [Education > Thumbs up, thumbs down; Nov 14, 2002]
>
> RITA 3: Routine intervention strategy halves angina for NSTEMI
> and UA patients at moderate risk
> [HeartWire > News; Sep 1, 2002]
>
>
>
>
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Any chance someone can turn this info into one paragraph ? Gifs are
voided and the info obtuse. Yet I trust the poster. Jim they said
robust ;)) ?
--
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