ArticlesCoronary angioplasty versus medical therapy for angina: the second Randomised Intervention Treatment of Angina (RITA-2) trial
Introduction
For patients with angina who require revascularisation, randomised trials comparing the long-term effects of coronary angioplasty and coronary artery bypass surgery1, 2, 3 have provided important information for clinical management. Randomised trials are also needed to determine whether patients in whom myocardial revascularisation is not essential should be treated by early angioplasty, or can have revascularisation deferred. The Veterans Administration Angioplasty Compared to Medicine trial4 is relevant but had limited power to detect clinically important differences.
The second Randomised Intervention Treatment of Angina (RITA-2) trial was designed to compare the effects of initial strategies of coronary angioplasty and conservative (medical) care over at least 5 years' follow-up in patients deemed suitable for either treatment. We present the interim results of RITA-2 after a median 2·7 years' follow-up.
Section snippets
Patients
Patients were recruited at 20 centres in the UK and Ireland. The ethics committee of each centre approved the protocol. Patients with coronary artery disease proven arteriographically were considered if the supervising cardiologist thought that both continued medical therapy and coronary angioplasty were acceptable alternatives. All eligible patients had a significant stenosis in at least one major epicardial vessel that appeared technically amenable to balloon dilatation. Patients had to be
Results
1018 patients were randomised to coronary angioplasty (504) or continued medical treatment (514). This report concerns follow-up to Nov 30, 1996, which was complete for 98% of patients. Minimum and median follow-ups were 6 months and 2·7 years respectively.
Discussion
RITA-2 was designed to compare initial policies of PTCA and medical care in patients with coronary artery disease in whom both treatments were deemed acceptable. Our patients ranged from those with no angina and single-vessel disease to those with severe symptoms and multivessel disease. Most had mild symptoms, one-vessel or two-vessel disease and preserved left-ventricular-function scores, and would be predicted to be at low cardiovascular risk.6, 13, 14 The patients were therefore not
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