K A A Fox， P A Poole-Wilson， R A Henderson， T C Clayton， D A Chamberlain， T R D Shaw， D J Wheatley， S J Pocock， for the Randomized Intervention Trial of unstable Angina (RITA) investigators*

Summary Background Current guidelines suggest that， for patients at moderate risk of death from unstable coronary-artery disease，either an interventional strategy (angiography followed by revascularisation) or a conservative strategy (ischaemia-driven or symptom-driven angiography) is appropriate. We aimed to test the hypothesis that an interventional strategy is better than a conservative strategy in such patients.

Methods We did a randomised multicentre trial of 1810 patients with non-ST-elevation acute coronary syndromes (mean age 62 years， 38% women). Patients were assigned an early intervention or conservative strategy. The antithrombin agent in both groups was enoxaparin. The coprimary endpoints were a combined rate of death， non-fatal myocardial infarction， or refractory angina at 4 months; and a combined rate of death or non-fatal myocardial infarction at 1 year. Analysis was by intention to treat.

Findings At 4 months， 86 (9·6%) of 895 patients in the intervention group had died or had a myocardial infarction or refractory angina， compared with 133 (14·5%) of 915 patients in the conservative group (risk ratio 0·66， 95% CI 0·51–0·85， p=0·001). This difference was mainly due to a halving of refractory angina in the intervention group. Death or myocardial infarction was similar in both treatment groups at 1 year (68 [7·6%] vs 76 [8·3%]， respectively; risk ratio 0·91， 95% CI 0·67–1·25， p=0·58). Symptoms of angina were improved and use of antianginal medications significantly reduced with the interventional strategy (p<0·0001).

Interpretation In patients presenting with unstable coronaryartery disease， an interventional strategy is preferable to a conservative strategy， mainly because of the halving of refractory or severe angina， and with no increased risk of death or myocardial infarction.