TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. cpcannon@partners.org
Glycoprotein (GP) IIb/IIIa inhibitors are beneficial in unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI). In large trials, the GP IIb/IIIa inhibitors tirofiban and eptifibatide were each found to reduce the risk of death or myocardial infarction (MI) in these patients at 30 days. These agents appear to be of greatest benefit in patients with a positive troponin at baseline, diabetes or ST-segment depression, recurrent angina, prior aspirin use, or a Thrombolysis In Myocardial Infarction (TIMI) risk score > or = 4. The Treat angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy (TACTICS) TIMI-18 trial was designed to compare the benefits of an early invasive versus a conservative strategy in high-risk UA/NSTEMI patients treated with GP IIb/IIIa inhibition. Patients were treated with tirofiban (for 48 h) plus aspirin and heparin and randomized to either invasive therapy (coronary angiography and revascularization when feasible) or conservative treatment (angiography only for patients with recurrent ischemia at rest or a positive stress test). A significant reduction in death or MI was demonstrated at 30 days (p = 0.02) and at 6 months (p = 0.0498). Death, MI, or rehospitalization for an acute coronary syndrome was also reduced with the invasive therapy at six months (p = 0.025). These results provide evidence to physicians that early GP IIb/IIIa inhibition in combination with a prompt invasive approach should be used more widely in UA/NSTEMI patients, particularly those at high risk.
Publication Types:
Review
Review, Tutorial
MeSH Terms:
Acute Disease
Angina, Unstable/drug therapy*
Angina, Unstable/mortality
Antibodies, Monoclonal/therapeutic use*
Coronary Thrombosis/prevention & control
Human
Immunoglobulins, Fab/therapeutic use*
Myocardial Infarction/drug therapy*
Myocardial Infarction/mortality
Peptides/therapeutic use*
Platelet Aggregation Inhibitors/therapeutic use*
Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors*
Risk Factors
Support, Non-U.S. Gov't
Substances:
Antibodies, Monoclonal
Immunoglobulins, Fab
Peptides
Platelet Aggregation Inhibitors
Platelet Glycoprotein GPIIb-IIIa Complex
eptifibatide
abciximab
PMID: 12644340 [PubMed - indexed for MEDLINE]
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