C. Unstable Angina and Non-ST Elevation Myocardial Infarction
1. Clinical Study — RITA 3 Investigators
Question posed: We will test the hypothesis that PCI is better than a conservative strategy in patients with unstable angina or non-ST elevation myocardial infarction.
Methods: A randomized multicenter trial of 1810 patients with acute coronary syndromes was used. Patients were assigned an early PCI or conservative strategy. The antithrombin agent in both groups was low molecular weight heparin, enoxaparin. Primary end points were a combined rate of death, nonfatal infarction, or refractory angina at four months and a combined rate of death or non fatal infarction at one year.
Results: At 4 months 86 (9.6%) of 895 patients in the PCI group had died or had a myocardial infarction or refractory angina versus 133 (14.5%) of 915 patients in the conservative group, p ¼ 0.001. This difference was mainly due to a halving of refractory angina in the intervention group. Death or infarction was similar in both groups at one year when symptoms of angina were improved with antianginal medications and significantly reduced with the interventional strategy ( p ¼ 0.0001). The procedural success rate after PTCA was approximately 80% 20 years ago compared with approximately 97% in recent years, including success in women.

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