Seven-year outcome in the RITA-2 trial: Coronary angioplasty versus medical therapy
Seven-year outcome in the RITA-2 trial: Coronary angioplasty versus medical therapy
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DOI：
10.1016/s0735-1097(03)00951-3
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发表时间：
2003-10-01
影响因子：
24
通讯作者：
Chamberlain, DA
中科院分区：
文献类型：
--
作者：
Henderson, RA;Pocock, SJ;Chamberlain, DA
结论：本研究旨在比较经皮冠状动脉腔内成形术（PTCA）和持续药物治疗的长期效果。方法第二次心绞痛随机干预治疗（RITA-2）是一项PTCA与保守治疗（药物）的随机试验。1，018名患者被认为适合任何一种治疗方案。结果73例（14.5%）PTCA患者和63例（12.3%）内科患者发生死亡或心肌梗死（MI）（差异为+2.2%，95%可信区间为-2.0%to +6.4%，p = 0.21）。两组共有43例死亡，其中41%与心脏有关。在接受PTCA的患者中，12.7%的患者随后接受了冠状动脉旁路移植术，14.5%的患者需要额外的非随机PTCA。这些再干预大多发生在随机化后一年内，两年后再干预率为每年2.3%。在医疗组中，35.4%需要心肌血运重建：第一年为15.0%，两年后的年发生率为3.6%。经皮冠状动脉成形术的初始策略与心绞痛症状的改善和运动时间有关。这些治疗差异随着时间的推移而缩小，主要是因为对症状严重的内科患者进行了冠状动脉介入治疗。结论在RITA-2中，PTCA的初始策略不会影响死亡或心肌梗死的风险，但它可以改善心绞痛和运动耐量。认为适合PTCA或药物治疗的患者可以通过持续药物治疗进行安全管理，但如果症状未得到控制，则应进行经皮介入治疗。(C)2003年由美国心脏病学会基金会。
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. (C) 2003 by the American College of Cardiology Foundation.