Condition category
Circulatory System
Date applied
Date assigned
Last edited
Retrospectively registered
Overall trial status
Recruitment status
No longer recruiting
Publication status

Plain English Summary

Not provided at time of registration

Trial website

Contact information



Primary contact

Prof Keith AA Fox


Contact details

Chancellor's Buiding
49 Little France Crescent
EH16 4SB
United Kingdom
+44 (0)131 536 2743

Additional identifiers

EudraCT number number

Protocol/serial number


Study information

Scientific title

Intervention versus conservative treatment strategy in patients with unstable angina or non-ST elevation myocardial infarction (the Third Randomised Intervention Treatment of Angina trials [RITA 3])



Study hypothesis

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.

Ethics approval

Multi-centre national ethics committee approval and local ethics committee approval were obtained

Study design

Randomised controlled trial

Primary study design


Secondary study design

Randomised controlled trial

Trial setting


Trial type


Patient information sheet

Patient information can be found on the website at:


Unstable angina/non-ST elevation myocardial infarction


Angiography followed by Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Grafting (CABG) versus conservative management.

Intervention type



Drug names

Primary outcome measure

The co-primary 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.

Secondary outcome measures

Secondary outcomes included subsequent revascularisation, angina scores, anti-anginal medication, quality-of-life scores, and health-economic evaluations.

Overall trial start date


Overall trial end date


Reason abandoned (if study stopped)


Participant inclusion criteria

Patients within 24 hours of an index episode of ischaemic pain at rest or patients will have documented evidence of coronary disease with at least one of:
1. Electrocardiogram (ECG) evidence of myocardial ischaemia
2. Pathological Q waves on an ECG suggesting previous myocardial infarction
3. Arteriographically proven coronary disease on a previous angiogram

Participant type


Age group




Target number of participants


Participant exclusion criteria

All those with probable evolving myocardial infarction, including those for whom reperfusion therapy was indicated, were ineligible. Those in A1 whom new pathological Q waves developed, or those with creatine kinase or creatine kinase Myocardial Bands (MB) concentrations twice the upper limit of normal before randomisation, were excluded. Also excluded were those with myocardial infarction within the previous month, Percutaneous Coronary Intervention (PCI) in the preceding 12 months, or Coronary Artery Bypass Grafting (CABG) at any time.

Recruitment start date


Recruitment end date



Countries of recruitment

United Kingdom

Trial participating centre

The University of Edinburgh
EH16 4SB
United Kingdom

Sponsor information


British Heart Foundation (UK)

Sponsor details

14 Fitzhardinge Street
United Kingdom
+44 (0)20 7935 0185

Sponsor type




Funder type


Funder name

British Heart Foundation (UK) (ref: RG/96001) - plus donation from Aventis to the British Heart Foundation

Alternative name(s)

Funding Body Type

Funding Body Subtype


Results and Publications

Publication and dissemination plan

Not provided at time of registration

Intention to publish date

Participant level data

Not provided at time of registration

Basic results (scientific)

Publication list

Results in:
1. 2004 results of impact of gender in
2. 2005 five-year outcomes results in
3. 2005 one-year results in
4. 2006 patient management and disease events results in
5. 2008 cost effectiveness study results in
6. 2012 collaborative analysis in
7. 2012 collaborative analysis in
8. 2012 collaborative analysis in
9. 2015 10-year results in:

Publication citations

  1. Results of impact of gender

    Clayton TC, Pocock SJ, Henderson RA, Poole-Wilson PA, Shaw TR, Knight R, Fox KA, Do men benefit more than women from an interventional strategy in patients with unstable angina or non-ST-elevation myocardial infarction? The impact of gender in the RITA 3 trial., Eur. Heart J., 2004, 25, 18, 1641-1650, doi: 10.1016/j.ehj.2004.07.032.

  2. Patient management and disease events results

    Poole-Wilson PA, Pocock SJ, Fox KA, Henderson RA, Wheatley DJ, Chamberlain DA, Shaw TR, Clayton TC, , Interventional versus conservative treatment in acute non-ST elevation coronary syndrome: time course of patient management and disease events over one year in the RITA 3 trial., Heart, 2006, 92, 10, 1473-1479, doi: 10.1136/hrt.2005.060541.

  3. Cost effectiveness study results

    Henriksson M, Epstein DM, Palmer SJ, Sculpher MJ, Clayton TC, Pocock SJ, Henderson RA, Buxton MJ, Fox KA, The cost-effectiveness of an early interventional strategy in non-ST-elevation acute coronary syndrome based on the RITA 3 trial., Heart, 2008, 94, 6, 717-723, doi: 10.1136/hrt.2007.127340.

  4. Collaborative analysis

    Damman P, Clayton T, Wallentin L, Lagerqvist B, Fox KA, Hirsch A, Windhausen F, Swahn E, Pocock SJ, Tijssen JG, de Winter RJ, Effects of age on long-term outcomes after a routine invasive or selective invasive strategy in patients presenting with non-ST segment elevation acute coronary syndromes: a collaborative analysis of individual data from the FRISC II - ICTUS - RITA-3 (FIR) trials., Heart, 2012, 98, 3, 207-213, doi: 10.1136/heartjnl-2011-300453.

  5. Collaborative analysis

    Damman P, Wallentin L, Fox KA, Windhausen F, Hirsch A, Clayton T, Pocock SJ, Lagerqvist B, Tijssen JG, de Winter RJ, Long-term cardiovascular mortality after procedure-related or spontaneous myocardial infarction in patients with non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II, ICTUS, and RITA-3 trials (FIR)., Circulation, 2012, 125, 4, 568-576, doi: 10.1161/CIRCULATIONAHA.111.061663.

  6. Collaborative analysis

    Damman P, van Geloven N, Wallentin L, Lagerqvist B, Fox KA, Clayton T, Pocock SJ, Hirsch A, Windhausen F, Tijssen JG, de Winter RJ, Timing of angiography with a routine invasive strategy and long-term outcomes in non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) Trials., JACC Cardiovasc Interv, 2012, 5, 2, 191-199, doi: 10.1016/j.jcin.2011.10.016.

  7. Fox KA, Poole-Wilson P, Clayton TC, Henderson RA, Shaw TR, Wheatley DJ, Knight R, Pocock SJ, 5-year outcome of an interventional strategy in non-ST-elevation acute coronary syndrome: the British Heart Foundation RITA 3 randomised trial., Lancet, 366, 9489, 914-920, doi: 10.1016/S0140-6736(05)67222-4.

  8. Kim J, Henderson RA, Pocock SJ, Clayton T, Sculpher MJ, Fox KA, , Health-related quality of life after interventional or conservative strategy in patients with unstable angina or non-ST-segment elevation myocardial infarction: one-year results of the third Randomized Intervention Trial of unstable Angina (RITA-3)., J. Am. Coll. Cardiol., 2005, 45, 2, 221-228, doi: 10.1016/j.jacc.2004.10.034.

  9. Results

    Henderson RA, Jarvis C, Clayton T, Pocock SJ, Fox KA, 10-Year Mortality Outcome of a Routine Invasive Strategy Versus a Selective Invasive Strategy in Non-ST-Segment Elevation Acute Coronary Syndrome: The British Heart Foundation RITA-3 Randomized Trial, J Am Coll Cardiol, 2015, 66, 5, 511-520, doi: 10.1016/j.jacc.2015.05.051.

Additional files

Editorial Notes