Coronary angioplasty versus coronary artery bypass surgery: the Randomized Intervention Treatment of Angina (RITA) trial.
Coronary angioplasty versus coronary artery bypass surgery: the Randomized Intervention Treatment of Angina (RITA) trial.
复制标题
冠状动脉血管成形术与冠状动脉搭桥手术：心绞痛随机干预治疗 (RITA) 试验。
DOI：
--
复制
发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Im Breckenridge
中科院分区：
文献类型：
--
作者：
Hampton;R. Henderson;D. Julian;J. Parker;S. Pocock;E. Sowton;J. Wallwork;D. Chamberlain;J. Dark;Joy;Paul Townsend Seed;B. Youard;A. Yates;P. Curry;P. Deverall;G. Jackson;C. Pumphrey;D. Parker;T. Treasure;J. Pepper;J. Smith;D. Ward;N. Brooks;H. Moussalli;D. Bennett;C. Bray;C. Campbell;A. Deiraniya;M. Jones;R. Lawson;A. Rahman;C. Ward;R. Balcon;P. Magee;C. Layton;A. Timmis;J. Wright;R. Swanton;W. Pugsley;P. Hubner;R. Firmin;A. Gershlick;T. Spyt;Db Okeffe;H. Okane;J. Cleland;D. Gladstone;P. Morton;J. Murtagh;M. Scott;S. Cobbe;D. Wheatley;F. Dunn;I. Hutton;A. Lorimer;A. Rae;W. Hillis;D. Dymond;S. Edmondson;S. Banim;D. Davies;A. Nathan;G. Reece;R. Spurrell;D. Cumberland;Gh Smith;G. Oakley;D. Jewitt;J. Keates;C. Bucknall;A. Forsyth;R. Wainwright;F. Shabbo;Jb Oriorden;P. Bloomfield;E. Cameron;D. Debono;M. Rothman;A. Wood;A. Macdonald;P. Mills;T. Lewis;R. Foale;R. Stanbridge;K. Fox;Im Breckenridge
心绞痛的随机干预治疗（RITA）试验比较了经皮腔内冠状动脉成形术（PTCA）和冠状动脉搭桥手术（CABG）对1、2或3条冠状动脉病变患者的长期效果，其中任何一种手术都可以实现等效的血运重建。第一份报告是对随机分配的1011名患者进行平均2.5年的随访。59%的人患有3级或4级心绞痛，59%的人在休息时经历过心绞痛，55%的人有两条或两条以上的冠状动脉病变。98%的患者完成了预期的手术。在97%的CABG患者中，所有预期的血管都被移植了。87%的PTCA患者尝试扩张所有治疗血管，每条血管的血管造影成功率为87%（排除闭塞血管为90%）。有34例死亡（18例CABG， 16例PTCA），预先确定的合并主要死亡事件或明确的心肌梗死没有证据表明治疗差异（43例CABG， 50例PTCA；相对危险度0.88[95%置信区间0.59-1.29]）。4%的PTCA患者在出院前需要紧急冠脉搭桥，另有15%的患者在随访期间进行了冠脉搭桥。在随机化的2年内，PTCA组和CABG组中分别有38%和11%的患者需要血管重建术或发生原发事件（p < 0.001）， PTCA患者在随访期间重复冠状动脉造影的发生率是CABG患者的4倍（31% vs 7%, p < 0.001）。PTCA组在随访期间心绞痛的患病率较高（例如，6个月时为32%对11%），但2年后差异变得不那么明显（31%对22%）。PTCA患者使用抗心绞痛药物的频率更高。在1个月时，CABG患者的体力活动较少，冠状动脉相关失业增加，平均运动时间低于PTCA患者。此后，就业状况、呼吸困难和身体活动得到改善，两个治疗组之间无显著差异。1年后，两组的平均运动时间都增加了3分钟。这些中期研究结果表明，CABG后的恢复时间比PTCA更长，CABG更具侵入性。然而，与PTCA相比，CABG在前2年导致心绞痛的风险更低，额外的诊断和治疗干预也更少。到目前为止，在死亡或心肌梗死的风险上没有显著差异，随访至少持续5年。
The Randomised Intervention Treatment of Angina (RITA) trial is comparing the long-term effects of percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG) in patients with one, two, or three diseased coronary arteries in whom equivalent revascularisation was deemed achievable by either procedure. This first report is for a mean 2.5 years' follow-up on the 1011 patients randomised. 59% had grade 3 or 4 angina, 59% had experienced angina at rest, and 55% had two or more diseased coronary arteries. The intended procedure was done in 98% of patients. In 97% of CABG patients all intended vessels were grafted. Dilatation of all treatment vessels was attempted in 87% of PTCA patients with an angiographic success rate per vessel of 87% (90% excluding occluded vessels). There have been 34 deaths (18 CABG, 16 PTCA) and the pre-defined combined primary event of death or definite myocardial infarction shows no evidence of a treatment difference (43 CABG, 50 PTCA; relative risk 0.88 [95% confidence interval 0.59-1.29]). 4% of PTCA patients required emergency CABG before discharge and a further 15% had CABG during follow-up. Within 2 years of randomisation 38% and 11% of the PTCA and CABG groups, respectively, required revascularisation procedure(s) or had a primary event (p < 0.001) and repeat coronary arteriography during follow-up was four times more common in PTCA than in CABG patients (31% vs 7%, p < 0.001). The prevalence of angina during follow-up was higher in the PTCA group (eg, 32% vs 11% at 6 months) but this difference became less marked after 2 years (31% vs 22%). Anti-anginal drugs were prescribed more frequently for PTCA patients. At 1 month CABG patients were less physically active, with greater coronary related unemployment and lower mean exercise times than the PTCA patients. Thereafter employment status, breathlessness, and physical activity improved, with no significant differences between the two treatment groups. At 1 year mean exercise times had increased by 3 min for both groups. These interim findings indicate that recovery after CABG, the more invasive procedure, takes longer than after PTCA. However, CABG leads to less risk of angina and fewer additional diagnostic and therapeutic interventions in the first 2 years than PTCA. So far, there is no significant difference in risk of death or myocardial infarction, and follow-up continues to at least five years.