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RITA-3: Routine arteriography fails to show 10-year survival benefit
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New 10-year follow-up data from the RITA-3 trial show no survival benefit associated with a routine early invasive strategy of coronary arteriography and myocardial revascularization compared with a selective invasive strategy of coronary arteriography for recurrent ischemia only among patients with non-ST segment elevation ACS.
The long-term data are in contrast to previously reported 5-year data, which demonstrated a 24% reduction in the odds of all-cause mortality with the routine early invasive approach.
Researchers for the British Heart Foundation RITA-3 randomized trial compared long-term outcomes for the routine early invasive strategy compared with the selective invasive strategy in 1,810 patients with non-ST segment elevation ACS (NSTEACS).
At 10 years, the rate of all-cause mortality was 25.1% in the routine early invasive strategy group vs. 25.4% in the selective invasive strategy group (P = .94) and the rate of CV mortality was 15.1% vs. 16.1%, respectively (P = .65).
“The mortality curves diverged over the first 5 years, but then progressively converged over the following 5 to 10 years,” the researchers wrote.
From years 0 to 5, the HR for all-cause mortality was 0.76 (95% CI, 0.59-0.98) in the routine early invasive strategy group vs. the selective invasive strategy group. The HR for all-cause mortality was increased from years 5 to 10 (HR = 1.28; 95% CI, 0.98-1.68). The researchers reported a similar trend for CV mortality (HR during years 0 to 5 = 0.7; 95% CI, 0.51-0.97; HR during years 5 to 10 = 1.29; 95% CI, 0.7-1.83).
When the researchers used a modified Global Registry of Acute Coronary Events (GRACE) risk score to stratify patients, those classified as low risk had a 10-year mortality rate of 14.4% vs. 56.2% for those classified as high risk. Intervention strategy had no effect on this survival trend, according to the researchers.
Predictors of 10-year mortality included age, history of MI, HF, smoking status, diabetes, heart rate and ST segment depression, according to results of a multivariable analysis.
“The advantage of reduced mortality of a routine early invasive strategy seen at 5 years attenuated during later follow-up,”’ the researchers concluded. “Further trials of contemporary intervention strategies in patients with NSTEACS are warranted.” – by Rob Volansky
Disclosure: The researchers report receiving a donation from Aventis Pharma. One researcher reports receiving grant support from The Medicines Company. All other researchers report no relevant financial disclosures.
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