Reductions in cardiovascular mortality and myocardial infarction (MI) associated with routine invasive treatment in patients with non-ST elevation acute coronary syndrome (non-STEACS) lessen over the course of 10 years, according to updated results from the RITA-3 Trial presented Sept. 2 at ESC Congress 2014.

Additional Resources ESC Congress 2014 Meeting Coverage RITA-3 Trial Summary Presentation Slides

The RITA-3 Trial randomized 1,801 patients to routine early invasive (coronary arteriography within 72 hours, with subsequent management guided by findings) or selective invasive strategies (coronary arteriography for recurrent or persistent myocardial ischemia only). Study results at five years indicated significant reductions in the odds of cardiovascular death and MI (26 percent), as well as all-cause mortality (24 percent), in patients assigned to the routine invasive group.

However, new data looking at patients 10 years post-intervention show no evidence of a difference in all-cause or cardiovascular mortality. According to study investigators, there were 225 deaths (25.1 percent) at 10 years in the routine invasive group, compared to 232 deaths (25.4 percent) in the selective invasive group (p=0.94). Cardiovascular mortality was also similar between the two groups (135 deaths [15.1 percent] versus 147 deaths [16.1 percent], p=0.65).

"The mortality advantage of a routine early invasive strategy seen at five years appears to be confined to patients at high risk and attenuates during follow-up to 10 years," investigators said. "Based on these findings, further analyses of contemporary intervention strategies in patients with non-STEACS are warranted." They also noted that an updated individual patient data meta-analysis of the FRISC, ICTUS and RITA trials is planned.

Keywords: Myocardial Infarction, Acute Coronary Syndrome, Follow-Up Studies, Myocardial Revascularization

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