Re: Five-year results from RITA-3 indicate less MI/death in patients treated with an early interventional strategy

The GIFs from this are not helpful. They just show people's faces.

What this says, roughly, is that if you have Acute Coronary Syndrome

http://www.americanheart.org/presenter.jhtml?identifier=3010002

(roughly chest pain due to lack of blood to the heart) and do not have ST
segment elevation - which is a thing that shows up on an EKG - it is still a
good idea to get an angiogram if you are at moderate to high risk of heart
disease in other respects. (If you do have ST segment elevation you are
probably going to have an angiogram.)

The benefits did not start showing up until after 1 year.

You can reconstruct the table by turning the colums below into rows. That is
the first column (that is by itself) is actually the first row.

This is the URL

http://www.theheart.org/viewArticle.do?primaryKey=558075&nl_id=tho08sep05


But it is a real pain to sign up for.


Bill

"William Wagner" <PainInAss__williamwag@xxxxxxxxx> wrote in message
news:PainInAss__williamwag-BC6947.16351808092005@xxxxxxxxxxxxxxxxxxxxx
> 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 ;)) ?
>
> --
> Garden Shade Zone 5 S Jersey USA in a Japanese Jungle
> Manner.39.6376 -75.0208
> This article is posted under fair use rules in accordance with
> Title 17 U.S.C. Section 107, and is strictly for the educational
> and informative purposes. This material is distributed without profit.
> Moose I'm trying to understand why Kamikaze pilots wear helments?


.

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