cantly reduced in patients assigned intervention, and that the main effect was on severe angina. Conclusive evidence for the effect on prognosis (death or heart attack) will require completion of the planned 5 year follow-up. As in previous studies, the hazards of intervention seem to be more than counterbalanced by the subsequent reduction in risk of heart attack."

In an accompanying Commentary (p 738), Lars Wallentin from University Hospital Uppsala, Sweden, concludes: "Based on the [previously published] randomised trials, RITA 3, observational data, and clinical experience, an early invasive compared with a non-invasive strategy improves survival without recurrence of myocardial infarction and re-admission or urgent revascularisation for severe angina. The effects are greatest in intermediate-risk and high-risk patients based on non-invasive risk indicators on admission. In women the effects on prognosis are uncertain and might be unfavourable, necessitating a more cautious approach to invasive procedures. These conclusions accord with the guidelines from the ESC [European Society of Cardiology] and ACC/American Heart Association that will be published in 2002. Further studies are needed to improve methods to reduce the risks associated with invasive procedures, to explore new treatment alternatives in women, and to prevent recurrences of instability in the longer term."

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Contact: Richard Lane
richard.lane@lancet.com
44- 20-7424-4949
Lancet
31-Aug-2002

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