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This trial is included in the following systematic reviews and meta-analyses:

acute coronary syndrome - myocardial revascularization - all type of patients  


Related trials

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ISAR-COOL, 2003 - early intervention vs early strategy

RITA 3, 2002 - routine invasive strategy vs concervative strategy

VINO, 2002 - routine invasive strategy vs concervative strategy

TACTICS-TIMI 18, 2001 - routine invasive strategy vs concervative strategy

TRUCS, 2000 - routine invasive strategy vs concervative strategy

FRISC 2, 1999 - routine invasive strategy vs concervative strategy

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See also:

  • All acute coronary syndrome clinical trials
  • All clinical trials of myocardial revascularization
  • All clinical trials of routine invasive strategy
    		•  

    TACTICS-TIMI 18 study, 2001

    Treatments

    Studied treatment early invasive management strategy
    coronary angiography at 4 to 48 hours
    Control treatment conservative management strategy
    medical therapy and predischarge exercise testing
    Treatments description
    history of MI 866 (39%) 
    Female (%) 34% 
    Age 62 
    Time to cardiac catheterization routine invasive group, h 22 h (median) 
    ST-segment elevation 266 (12%) 
    ST-segment depression 688 (31%) 
    T-wave inversion 777 (35%) 
    diabetes 28% 

    Patients

    Patients patients with non–ST-segment elevation acute coronary syndrome
    Inclusion criteria older than 18 years of age; episode of angina in the preceding 24 hours;
    Exclusion criteria persistent ST-segment elevation; secondary angina; percutaneous coronary revascularization or coronary bypass surgery within the previous 6 months; a history of gastrointestinal bleeding, platelet disorder, or thrombocytopenia; any history of hemorrhagic cerebrovascular disease or a history of nonhemorrhagic cerebrovascular disease or transient ischemic attack within 1 year; left bundle-branch block or paced rhythm; severe congestive heart failure or cardiogenic shock; clinically important systemic disease; serum creatinine concentration greater than 220 µmol/L; treatment with a glycoprotein IIb/IIIa antagonist within the past 96 hours; or ongoing long-term treatment with ticlopidine, clopidogrel, or warfarin
    Baseline characteristics
    GpIIb/IIIa inhibitors, % 94%/99% 
    Background antithrombotic treatment Aspirin, UFH, tirofiban 
    Time to cardiac catheterization, median (h) 22/79 
    Thrombolytic therapy 0 
    Suspected MI at randomization 826 (37%) 
    Revascularization during initial hopsitalization (routine/selective) % 60%/36% 
    revascularization at end of follow up (routine/selective) % 61/44 
    PCI with stent (%) 83/86 
    Inductible ischemia in conservative strategy No recommendation 
    Thienopyridine with PCI, % NA 
    Statin at follow-up, % NA 

    Method and design

    Randomized effectives 1114 / 1106 (studied vs. control)
    Design Parallel groups
    Blinding open
    Follow-up duration 6 mo
    Number of centre 169
    Geographic area 9 countries
    Hypothesis Superiority


    Results

    Endpoint Studied treat.
    n/N     Control treat.
    n/N     Graph RR [95% CI]

    In hospital non fatal MI

    27 / 1114
         44 / 1106
         0,61 [0,38;0,98]

    In-hospital death

    16 / 1114
         8 / 1106
         classic 1,99 [0,85;4,62]

    In hospital death or MI

    38 / 1114
         49 / 1106
         0,77 [0,51;1,17]

    All cause death

    37 / 1114
         39 / 1106
         0,94 [0,61;1,47]

    Deaths or MI

    81 / 1114
         105 / 1106
         0,77 [0,58;1,01]

    rehospitalization

    123 / 1114
         152 / 1106
         0,80 [0,64;1,00]

    Non fatal MI

    53 / 1114
         76 / 1106
         0,69 [0,49;0,97]

    CCS class III-IV angina

    80 / 1114
         73 / 1106
         1,09 [0,80;1,48]     0 2 1.0

    Relative risks
    Endpoint Events (%) Relative Risk 95% CI Endpoint definition
    in the trial    		 Ref
    Studied treat. Control treat.
    In hospital non fatal MI 27 / 1114 (2,4%) 44 / 1106 (4,0%) 0,61 [0,38;0,98]    
    In-hospital death 16 / 1114 (1,4%) 8 / 1106 (0,7%) 1,99 [0,85;4,62]    
    In hospital death or MI 38 / 1114 (3,4%) 49 / 1106 (4,4%) 0,77 [0,51;1,17]    
    All cause death 37 / 1114 (3,3%) 39 / 1106 (3,5%) 0,94 [0,61;1,47]    
    Deaths or MI 81 / 1114 (7,3%) 105 / 1106 (9,5%) 0,77 [0,58;1,01]    
    rehospitalization 123 / 1114 (11,0%) 152 / 1106 (13,7%) 0,80 [0,64;1,00]    
    Non fatal MI 53 / 1114 (4,8%) 76 / 1106 (6,9%) 0,69 [0,49;0,97]    
    CCS class III-IV angina 80 / 1114 (7,2%) 73 / 1106 (6,6%) 1,09 [0,80;1,48]    
    The primary endpoint (if exists) appears in blod characters
    Reference(s) used for data extraction:
  • 0:

    • Endpoint studied treat. control treat. mean diff

    Absolute risk reduction
    Endpoint Events rate Absolute risk
    reduction (ARR)
    Studied treat. Control treat.
    In hospital non fatal MI 2,42% 3,98% -15,5‰
    In-hospital death 1,44% 7,23‰ 7,1‰
    In hospital death or MI 3,41% 4,43% -10,2‰
    All cause death 3,32% 3,53% -2,0‰
    Deaths or MI 7,27% 9,49% -22,2‰
    rehospitalization 11,04% 13,74% -27,0‰
    Non fatal MI 4,76% 6,87% -21,1‰
    CCS class III-IV angina 7,18% 6,60% 5,8‰


    Reference(s)

    Trials register # NA
    • Cannon CP, Weintraub WS, Demopoulos LA, Vicari R, Frey MJ, Lakkis N, Neumann FJ, Robertson DH, DeLucca PT, DiBattiste PM, Gibson CM, Braunwald E. 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;344:1879-87
      Pubmed | Hubmed | Fulltext

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