PROCEEDINGS From

ESC CONGRESS 2014

RITA 3

10-year mortality outcome of a routine invasive

strategy in

Non-ST segment Elevation Acute Coronary

Syndrome: The British Heart Foundation RITA 3

randomised trial. (ISRCTN 07752711) Robert A Henderson

Introduction

• Randomised trial of routine invasive versus selective invasive

strategies

1810 pts with NSTE ACS

• At 5 years a routine invasive strategy was associated with:

– 26% reduction in the odds of CV death and MI

– 24% reduction in the odds of all cause mortality

• The benefits of routine invasive treatment appeared greatest in

patients at highest baseline ischaemic risk

• The objective of this analysis is to determine the impact of a

routine invasive strategy on longer-term (10 year) mortality

Methods

RITA-3 was designed to document clinical events to 5 years by

patient contact (vital status known at 5 years for 99.6%)

Thereafter, all patients were prospectively registered with ONS

(England) & GRO (Scotland) to ascertain deaths from national

mortality data.

All-cause mortality at 10 years was a pre-specified secondary

outcome

Modified post-discharge GRACE score* was used to calculate

a risk score for each patient and form low, medium & high risk

groups with approximately one-third of deaths in each group

Baseline renal function and in-hospital PCI

were excluded from the risk model

Eagle JAMA 2004;291:2727

ONS - Office of National

Statistics

GRO - General Register Office

Conclusion

The mortality advantage of a routine invasive strategy seen in RITA-3

at 5 years attenuated during later follow-up

At 10 years there was no evidence of a difference in all-cause or

cardiovascular mortality .

An updated IPD meta-analysis of FRISC, ICTUS and RITA-3 is

planned.

Further trials of contemporary intervention strategies in patients with

NSTE-ACS are warranted particularly in high risk patients.

Lars Wallentin, Ralph A. H. Stewart et al.

Objectives

This predefined part of the STABILITY study of patients with stable

CHD with optimal medical treatment raised the following questions:

Is Lp-PLA2 activity prognostic for outcomes?

Which factors contribute to high Lp-PLA2 activity?

Does darapladib provide persistent long-term reduction of

Lp-PLA2 activity?

Does high Lp-PLA2 activity identify patients with a larger

benefit of darapladib treatment?

Conclusions

In patients with stable CHD (3.7 years on a background of OMT):

Lp-PLA2 activity is an independent risk marker for CV events.

Dyslipidemia, Male gender, white race & NA region contribute to

higher Lp-PLA2 activity while statin treatment is associated with

lower Lp-PLA2 activity levels.

Darapladib provides a persistent ,a 65% reduction of the Lp-PLA2

activity during treatment.

Lp-PLA2 activity at baseline do not predict the effects of darapladib

treatment on coronary events.

Implications

In patients with stable CHD:

Lp-PLA2 activity level does not identify patients with a specific

effect of darapladib treatment.

Lp-PLA2 activity might be an indicator or part of an atherosclerotic

process although lowering of the activity does not have a clinically

significant effect in subjects treated with optimal standard of care.

Measuring Lp-PLA2 activity for identification of the risk of

cardiovascular events, without indication for a specific treatment,

needs further evaluation.

Background

Diabetes mellitus (DM) is involved in AS development and is

associated with qualitative changes in valvular tissue (inflammation,

metalloproteinase)

DM has a negative impact on immediate and long term outcome after

surgical aortic replacement.

While DM is not part of the Euroscore, it has been integrated to the

STS score.

The impact of DM on post-transcatheter aortic valve replacement

(TAVR) outcome is unknown.