TACTICS-TIMI 18
Trial question
Is early invasive strategy superior to conservative (selectively invasive) strategy in patients with unstable angina and myocardial infarction without ST-segment elevation who were treated with aspirin, heparin, and the glycoprotein IIb/IIIa inhibitor tirofiban?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
34.0% female
66.0% male
N = 2220
2220 patients (757 female, 1463 male)
Inclusion criteria: patients with unstable angina and myocardial infarction without ST-segment elevation who were treated with aspirin, heparin, and the glycoprotein IIb/IIIa inhibitor tirofiban
Key exclusion criteria: persistent ST-segment elevation, secondary angina, a history of percutaneous coronary revascularization or CABG within the preceding six months, increased risk of bleeding, severe congestive HF or cardiogenic shock, or serious systemic disease
Interventions
N=1114 early invasive coronary artery catheterization (routine catheterization within 4 to 48 hours and revascularization as appropriate)
N=1106 conservative coronary artery catheterization (catheterization performed only if the patient had objective evidence of recurrent ischemia or an abnormal stress test)
Primary outcome
Death, nonfatal MI, or rehospitalization for an acute coronary syndrome at 6 months
15.9
19.4
19.4 %
14.5 %
9.7 %
4.8 %
0.0 %
Early invasive coronary artery
catheterization
Conservative coronary artery
catheterization
Significant
decrease ▼
NNT = 28
Significant decrease in death, nonfatal MI, or rehospitalization for an acute coronary syndrome at 6 months (15.9% vs. 19.4%; OR 0.78, 95% CI 0.62 to 0.97)
Secondary outcomes
Borderline significant decrease in death or nonfatal MI at 6 months (7.3% vs. 9.5%; OR 0.74, 95% CI 0.54 to 1)
Conclusion
In patients with unstable angina and myocardial infarction without ST-segment elevation who were treated with aspirin, heparin, and the glycoprotein IIb/IIIa inhibitor tirofiban, early invasive coronary artery catheterization was superior to conservative coronary artery catheterization with respect to death, nonfatal MI, or rehospitalization for an acute coronary syndrome at 6 months.
Reference
Cannon CP, Weintraub WS, Demopoulos LA et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb / IIIa inhibitor tirofiban. N Engl J Med. 2001 Jun 21;344(25):1879-87.
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