INVASIVE VERSUS CONSERVATIVE STRATEGIES IN UNSTABLE ANGINA AND NON-Q-WAVE MYOCARDIAL-INFARCTION FOLLOWING TREATMENT WITH TIROFIBAN - RATIONALE AND STUDY DESIGN OF THE INTERNATIONAL TACTICS-TIMI-18 TRIAL

In the management of unstable angina and non-Q-wave acute myocardial i nfarction (AMI), there is considerable debate regarding the use of inv asive strategy versus conservative strategy. The Thrombolysis In Myoca rdial Infarction (TIMI) III B trial found similar clinical outcomes fo r the 2 strategies, but the Veterans Administration Non-Q-Wave Infarct ion Strategies in-Hospital trial found a higher mortality with the inv asive strategy. Both these trials were conducted before platelet glyco protein IIb/IIIa inhibition and coronary stenting, bath of which impro ve clinical outcome. Thus, there is a need to reexamine the question o f which management strategy is optimal in the current era of platelet glycoprotein IIb/IIIa inhibition and new coronary interventions. The T reat Angina with Aggrastat and determine Cost of Therapy with an Invas ive or Conservative Strategy (TACTICS-TIMI 18) trial is an internation al, multicenter, randomized trial that is evaluating the clinical effi cacy of early invasive and early conservative treatment strategies in patients with unstable angina or non-Q-wave AMI treated with tirofiban , heparin, and aspirin. Patients are randomized to an invasive strateg y, involving cardiac catheterization within 4 to 48 hours and revascul arization with angioplasty or bypass surgery if feasible, versus a con servative strategy, where patients are referred for catheterization on ly for recurrent pain at rest or provokable ischemia. The primary end point is death, MI, or rehospitalization for acute coronary syndromes through a 6-month follow-up. The trial is also testing the ''troponin hypothesis,'' that baseline troponins T and I will be useful in select ing an optimal management strategy. (C) 1998 by Excerpta Medica, Inc.