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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.NEJM

Abstract

BACKGROUND

There is continued debate as to whether a routine, early invasive strategy is superior to a conservative strategy for the management of unstable angina and myocardial infarction without ST-segment elevation.

METHODS

We enrolled 2220 patients with unstable angina and myocardial infarction without ST-segment elevation who had electrocardiographic evidence of changes in the ST segment or T wave, elevated levels of cardiac markers, a history of coronary artery disease, or all three findings. All patients were treated with aspirin, heparin, and the glycoprotein IIb/IIIa inhibitor tirofiban. They were randomly assigned to an early invasive strategy, which included routine catheterization within 4 to 48 hours and revascularization as appropriate, or to a more conservative (selectively invasive) strategy, in which catheterization was performed only if the patient had objective evidence of recurrent ischemia or an abnormal stress test. The primary end point was a composite of death, nonfatal myocardial infarction, and rehospitalization for an acute coronary syndrome at six months.

RESULTS

At six months, the rate of the primary end point was 15.9 percent with use of the early invasive strategy and 19.4 percent with use of the conservative strategy (odds ratio, 0.78; 95 percent confidence interval, 0.62 to 0.97; P=0.025). The rate of death or nonfatal myocardial infarction at six months was similarly reduced (7.3 percent vs. 9.5 percent; odds ratio, 0.74; 95 percent confidence interval, 0.54 to 1.00; P<0.05).

CONCLUSIONS

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.

Authors+Show Affiliations

Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA. cpcannon@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

11419424

Citation

Cannon, C P., et al. "Comparison of Early Invasive and Conservative Strategies in Patients With Unstable Coronary Syndromes Treated With the Glycoprotein IIb/IIIa Inhibitor Tirofiban." The New England Journal of Medicine, vol. 344, no. 25, 2001, pp. 1879-87.
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;344(25):1879-87.
Cannon, C. P., Weintraub, W. S., Demopoulos, L. A., Vicari, R., Frey, M. J., Lakkis, N., Neumann, F. J., Robertson, D. H., DeLucca, P. T., DiBattiste, P. M., Gibson, C. M., & Braunwald, E. (2001). Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. The New England Journal of Medicine, 344(25), 1879-87.
Cannon CP, 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. PubMed PMID: 11419424.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. AU - Cannon,C P, AU - Weintraub,W S, AU - Demopoulos,L A, AU - Vicari,R, AU - Frey,M J, AU - Lakkis,N, AU - Neumann,F J, AU - Robertson,D H, AU - DeLucca,P T, AU - DiBattiste,P M, AU - Gibson,C M, AU - Braunwald,E, AU - ,, PY - 2001/6/23/pubmed PY - 2001/6/29/medline PY - 2001/6/23/entrez SP - 1879 EP - 87 JF - The New England journal of medicine JO - N Engl J Med VL - 344 IS - 25 N2 - BACKGROUND: There is continued debate as to whether a routine, early invasive strategy is superior to a conservative strategy for the management of unstable angina and myocardial infarction without ST-segment elevation. METHODS: We enrolled 2220 patients with unstable angina and myocardial infarction without ST-segment elevation who had electrocardiographic evidence of changes in the ST segment or T wave, elevated levels of cardiac markers, a history of coronary artery disease, or all three findings. All patients were treated with aspirin, heparin, and the glycoprotein IIb/IIIa inhibitor tirofiban. They were randomly assigned to an early invasive strategy, which included routine catheterization within 4 to 48 hours and revascularization as appropriate, or to a more conservative (selectively invasive) strategy, in which catheterization was performed only if the patient had objective evidence of recurrent ischemia or an abnormal stress test. The primary end point was a composite of death, nonfatal myocardial infarction, and rehospitalization for an acute coronary syndrome at six months. RESULTS: At six months, the rate of the primary end point was 15.9 percent with use of the early invasive strategy and 19.4 percent with use of the conservative strategy (odds ratio, 0.78; 95 percent confidence interval, 0.62 to 0.97; P=0.025). The rate of death or nonfatal myocardial infarction at six months was similarly reduced (7.3 percent vs. 9.5 percent; odds ratio, 0.74; 95 percent confidence interval, 0.54 to 1.00; P<0.05). CONCLUSIONS: 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. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/11419424/Comparison_of_early_invasive_and_conservative_strategies_in_patients_with_unstable_coronary_syndromes_treated_with_the_glycoprotein_IIb/IIIa_inhibitor_tirofiban_ L2 - https://www.nejm.org/doi/10.1056/NEJM200106213442501?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -