Comparison of Early Invasive and Conservative Strategies in Patients with Unstable Coronary Syndromes Treated with the Glycoprotein IIb/IIIa Inhibitor Tirofiban

Abstract

In patients with unstable angina and myocardial infarction without ST-segment elevation who were treated with the glycoprotein IIb/IIIa inhibitor tirofiban, the use of an early invasive strategy significantly reduced the incidence of major cardiac events. These data support a policy involving broader use of the early inhibition of glycoprotein IIb/IIIa in combination with an early invasive strategy in such patients.

A population‐based evaluation of the thrombolysis in myocardial infarction risk score for unstable angina and non‐ST elevation myocardial infarction

“…An increase in the TIMI-RS was also significantly associated with increased rates of revascularization and a trend toward higher reinfarction rates. The results are consistent with the initial retrospective analysis from follow-up data at 14 days as described by Antman et al, 18 and the prospective evaluation completed in the TACTICS-TIMI 18 21 trial with 30-day follow-up. The OR estimates of the individual characteristics are very similar to the retrospective analysis with the exception of cardiac markers.…”

“…19,20 Prospective validation of the TIMI-RS has been performed in patients selected for the Treat Angina with aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy (TACTICS)-TIMI 18 trial. 21 In clinical trial settings, for which higher-risk patients are selected, the TIMI-RS has consistently and successfully differentiated a patient's risk of developing major adverse cardiac events into a low-, intermediate-, or high-risk category. 21,22 The risk score is not well established in the general population with chest pain.…”

“…21 In clinical trial settings, for which higher-risk patients are selected, the TIMI-RS has consistently and successfully differentiated a patient's risk of developing major adverse cardiac events into a low-, intermediate-, or high-risk category. 21,22 The risk score is not well established in the general population with chest pain. Recently, the TIMI-RS was applied to the TIMI III registry with two modifications.…”

Same-day transfer of patients with unstable angina and non-ST segment elevation myocardial infarction back to their referring hospital after angioplasty

“…E vidence from the literature recommends an early invasive strategy for patients with high-risk unstable angina (UA) and non-ST segment elevation myocardial infarction (NSTEMI) (1,2). However, the application of this strategy for patients from community hospitals has been limited by the availability of tertiary care facilities and long waiting lists.…”

Variation in Practice Regarding Pretreatment With Dual Antiplatelet Therapy for Patients With Non–ST Elevation Myocardial Infarction

“…Many clinical considerations might support not using DAPT pretreatment, such as concerns for increased bleeding risk (eg, patients with low baseline hemoglobin, with low platelet counts, or taking long‐term anticoagulants) or the expectation that the patients with NSTEMI might have underlying severe coronary vessel disease requiring coronary artery bypass graft surgery (CABG) 4, 5, 6, 7, 8, 9. Prediction models to detect the risk of bleeding after percutaneous coronary intervention (PCI), as well as to estimate the probability of undergoing CABG after a NSTEMI,10, 11, 12, 13 have been developed to support such decisions, but whether avoiding DAPT pretreatment is associated with patient‐centered risks is unknown.…”