Reply: Do the 10-Year Mortality Outcomes of RITA-3 Inform Contemporary Clinical Practice?

RITA-3 enrolled patients before the introduction of serum troponin as a routine biomarker of myocardial necrosis, but 92% had evidence of myocardial ischemia on a baseline electrocardiogram (ST-segment deviation in 43%) and it is likely that the majority would have been biomarker positive using contemporary high-sensitivity troponin assays. [...]the adverse cardiovascular event rates at 5 years in the FRISC-2 (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes), and RITA-3 trials were similar, with all-cause mortality rates of 10.1%, 9.9%, and 15.1%, respectively (2), suggesting that the 3 major trials of routine invasive versus selective invasive strategies in NSTE-ACS enrolled patients at broadly comparable levels of cardiovascular risk.