Abstract 4333: Heterogeneity in Revascularization in Non-ST-elevation Acute Coronary Syndromes and the Effect on Long-term Clinical Outcomes Mortality and Myocardial Infarction: A Collaborative Analysis of Individual Patient Data From the FRISC-II, ICTUS, RITA-3 Trials
Background: An early invasive strategy and conservative strategy are alternative treatments for patients presenting with non-ST-segment elevation acute coronary syndrome. These strategies have been compared in several randomized trials, with different long-term clinical outcomes. We undertook a collaborative analysis of data from the FRISC-II, ICTUS and RITA-3 trials to assess whether the effects of the strategies on clinical outcomes are modified by the intensity of revascularization.
Methods: We pooled individual patient data (n=5467) and formed three intensity of revascularization groups, based on the revascularization rates during initial hospitalization. The high intensity group included the ICTUS and FRISC II invasive arms (76% & 76%), the intermediate intensity group included the ICTUS conservative (40%) and RITA-3 invasive arms (44%), and the low intensity group included the FRISC II and RITA-3 conservative arms (13% & 10%). The main composite outcome was death or myocardial infarction (MI) up to 5 years of follow-up. Adjusted survival curves and HRs were obtained with Cox proportional hazards models. Adjustedment was for differences in risk profile and baseline characteristics.
Results: The adjusted survival curves and adjusted HRs are shown in figure 1⇓. A low intensity of revascularization is associated with a worse long term clinical outcome (HR 1.37 when compared to a high intensity, HR 1.41 when compared to an intermediate intensity).
Conclusion: Variation in long-term outcomes between trials can be explained by variation in the intensity of revascularization of compared treatment strategies, a low intensity is associated with worse 5-year outcomes.