Implications of upstream glycoprotein IIb/IIIa inhibition and coronary artery stenting in the invasive management of unstable angina/non-ST-elevation myocardial infarction: A comparison of the thrombolysis in myocardial infarction (TIMI) IIIB trial and the treat angina with aggrastat and determine cost of therapy with invasive or conservative strategy (TACTICS)-TIMI 18 trial

TIMI IIIB and TACTICS-TIMI 18 were 2 trials of an early invasive strategy in unstable angina (UA)/non-ST-elevation myocardial infarction (NSTEMI) that were conducted nearly a decade apart but with virtually identical enrollment criteria and designs, except that upstream glycoprotein IIb/IIIa inhibit...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 2004-02, Vol.109 (7), p.874-880
Main Authors: SABATINE, Marc S, MORROW, David A, BRAUNWALD, Eugene, GIUGLIANO, Robert P, MURPHY, Sabina A, DEMOPOULOS, Laura A, DIBATTISTE, Peter M, WEINTRAUB, William S, MCCABE, Carolyn H, ANTMAN, Elliott M, CANNON, Christopher P
Format: Article
Language:English
Subjects:
Aged
Angina, Unstable - drug therapy
Angina, Unstable - surgery
Angioplasty, Balloon, Coronary
Aspirin - therapeutic use
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Combined Modality Therapy
Comorbidity
Coronary Disease - epidemiology
Coronary Disease - mortality
Coronary Disease - prevention & control
Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous
Female
Hospitalization - statistics & numerical data
Humans
Life Tables
Male
Medical sciences
Middle Aged
Multicenter Studies as Topic - statistics & numerical data
Myocardial Infarction - drug therapy
Myocardial Infarction - physiopathology
Myocardial Infarction - surgery
Platelet Aggregation Inhibitors - pharmacology
Platelet Aggregation Inhibitors - therapeutic use
Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors
Randomized Controlled Trials as Topic - statistics & numerical data
Recurrence
Retrospective Studies
Risk Factors
Severity of Illness Index
Stents
Survival Analysis
Thrombolytic Therapy
Treatment Outcome
Tyrosine - analogs & derivatives
Tyrosine - therapeutic use
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Summary:TIMI IIIB and TACTICS-TIMI 18 were 2 trials of an early invasive strategy in unstable angina (UA)/non-ST-elevation myocardial infarction (NSTEMI) that were conducted nearly a decade apart but with virtually identical enrollment criteria and designs, except that upstream glycoprotein IIb/IIIa inhibition was mandated and coronary artery stenting was routinely used in TACTICS-TIMI 18. We sought to examine the effect of these advances on clinical outcomes and the benefits of an early invasive strategy in UA/NSTEMI. Patients were stratified on the basis of their TIMI risk score into low-, intermediate-, and high-risk categories. Within each risk category, the rates of clinical outcomes and the benefit of an early invasive strategy were compared. Compared with patients in TIMI IIIB and adjusting for baseline risk, patients in TACTICS-TIMI 18 had lower rates of death, MI, or rehospitalization for acute coronary syndromes (OR, 0.62; P
ISSN:0009-7322
1524-4539
DOI:10.1161/01.CIR.0000112604.74713.35