Problem NSTEMI/UA (mod-high risk)
Format Multi-center RCT
Treatment Angiography +- PCI within 48h
Control Medical therapy
Population 1810 patients
Inclusion criteria Suspected cardiac chest pain at rest and had documented evidence of coronary artery disease with at least one of:
-Evidence of ischaemia on electrocardiograph (ST-segment depression, transient ST elevation, left bundle branch block [documented previously], or T-wave inversion)
-Pathological Q waves suggesting previous myocardial infarction
-Arteriographically proven coronary artery disease on a previous arteriogram.

Exclusion criteria Those with probable evolving myocardial infarction, including those for whom reperfusion therapy was indic.
Those in whom new pathological Q waves developed
Those with creatine kinase or creatine kinase MB concentrations twice the upper limit of normal before randomisation
Myocardial infarction within the previous month
PCI in the preceding 12 months
CABG at any time.
Follow-up 5 years
Primary endpoint Co-primary endpoints of:
-combined rate of death, non-fatal myocardial infarction, or refractory angina at 4 months
-Combined rate of death or non-fatal myocardial infarction at 1 year
Secondary endpoint(s) Angina scores
Quality-of-life scores
Health-economic evaluations
Details .
Brief summary: PCI reduced death/MI in high risk patients, near-significant ACM reduction
PAPER: Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarction: the British Heart Foundation RITA 3 randomised trial.
Date 7 Sep 2002
Journal Lancet. 2002 Sep 7;360(9335):743-51.
Information Aniography +- PCI vs. conservative management
N.B. In moderate/high risk groups
-Significantly reduced death/MI/angina @ 4 months (RR=0.66; p=0.001)
-Significantly reduced angina @ 4 months (RR=0.47; p<0.0001) & 1 year (RR=0.56; p=0.0002)
-No significant difference in Death, MI @ 1 year (p=0.58)
PAPER: 5-year outcome of an interventional strategy in non-ST-elevation acute coronary syndrome: the British Heart Foundation RITA 3 randomised trial.
Date 10 Sep 2005
Journal Lancet. 2005 Sep 10-16;366(9489):914-20.
Information PCI vs. conservative Mx @ 5yr
N.B. Moderate/high risk patients only
-Significantly reduced death/MI (RR=0.78; p=0.044)
-Almost-significant reduction in death (RR=0.76; p=0.054)
-Significantly reduced CV death (RR=0.026; p=0.026) and CV death/MI (RR=0.74; p=0.030)