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J Am Coll Cardiol, 2003; 42:1161-1170, doi:10.1016/S0735-1097(03)00951-3 © 2003 by the American College of Cardiology Foundation |
* Nottingham City Hospital, Nottingham, United Kingdom
London School of Hygiene and Tropical Medicine, London, United Kingdom
Royal Infirmary, Edinburgh, United Kingdom
London, United Kingdom
|| Pre-hospital Emergency Research Unit and Wales Heart Institute, University of Wales College of Medicine, Cardiff, United Kingdom
Manuscript received September 13, 2002; revised manuscript received March 31, 2003, accepted April 3, 2003.
* Reprint requests and correspondence: Dr. Robert A. Henderson, Department of Cardiology, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
rhender1{at}ncht.trent.nhs.uk
OBJECTIVES: This study was designed to compare the long-term consequences of percutaneous transluminal coronary angioplasty (PTCA) and continued medical treatment.
BACKGROUND: The long-term effects of percutaneous coronary intervention need evaluating, especially in comparison with an alternative policy of continued medical treatment.
METHODS: The Second Randomized Intervention Treatment of Angina (RITA-2) is a randomized trial of PTCA versus conservative (medical) care in 1,018 patients considered suitable for either treatment option. Information on clinical events, interventions, and symptoms is available for a median seven years follow-up.
RESULTS: Death or myocardial infarction (MI) occurred in 73 (14.5%) PTCA patients and 63 (12.3%) medical patients (difference +2.2%, 95% confidence interval –2.0% to +6.4%, p = 0.21). There were 43 deaths in both groups, of which 41% were cardiac-related. Among patients assigned PTCA 12.7% subsequently had coronary artery bypass grafts, and 14.5% required additional non-randomized PTCA. Most of these re-interventions occurred within a year of randomization, and after two years the re-intervention rate was 2.3% per annum. In the medical group, 35.4% required myocardial revascularization: 15.0% in the first year and an annual rate of 3.6% after two years. An initial policy of PTCA was associated with improved anginal symptoms and exercise times. These treatment differences narrowed over time, mainly because of coronary interventions in medical patients with severe symptoms.
CONCLUSIONS: In RITA-2 an initial strategy of PTCA did not influence the risk of death or MI, but it improved angina and exercise tolerance. Patients considered suitable for PTCA or medical therapy can be safely managed with continued medical therapy, but percutaneous intervention is appropriate if symptoms are not controlled.
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