6/30/23, 2:15 AM TACTICS-TIMI 18 Pathway Feedback Search Clinical Topics Home Studies TACTICS TIMI 18 TACTICS TIMI 18 Disease Non-ST-elevation myocardial inf Trial question Is early invasive strategy superior to conservative (selectively invasive) strategy in patients with unstable angina and myocardial infarction without ST-segment elevation who were treated with aspirin, heparin, and the glycoprotein IIb/IIIa inhibitor tirofiban? Study design Multi-center Open label RCT Population Characteristics of study participants 34.0% female N = 2220 66.0% male 2220 patients (757 female, 1463 male) Inclusion criteria: patients with unstable angina and myocardial infarction without ST-segment elevation who were treated with aspirin, heparin, and the glycoprotein IIb/IIIa inhibitor tirofiban Key exclusion criteria: persistent ST-segment elevation, secondary angina, a history of percutaneous coronary revascularization or CABG within the preceding six months, increased risk of bleeding, severe congestive HF or cardiogenic shock, or serious systemic disease Interventions N=1114 early invasive coronary artery catheterization (routine catheterization within 4 to 48 hours and revascularization as appropriate) https://web.pathway.md/studies/recUqX5D50AlMsnZn 1/2 6/30/23, 2:15 AM TACTICS-TIMI 18 Pathway N=1106 conservative coronary artery catheterization (catheterization performed only if the patient had objective evidence of recurrent ischemia or an abnormal stress test) Primary outcome Death, nonfatal MI, or rehospitalization for an acute coronary syndrome at 6 months 19.4 % 19.4 15.9 14.5 % 9.7 % Significant decrease 4.8 % NNT = 29 0.0 % Early invasive coronary artery catheterization Conservative coronary artery catheterization Significant decrease in death, nonfatal MI, or rehospitalization for an acute coronary syndrome at 6 months (15.9% vs. 19.4%; OR 0.78, 95% CI 0.62 to 0.97) Secondary outcomes Borderline significant decrease in death or nonfatal MI at 6 months (7.3% vs. 9.5%; OR 0.74, 95% CI 0.54 to 1) Conclusion In patients with unstable angina and myocardial infarction without ST-segment elevation who were treated with aspirin, heparin, and the glycoprotein IIb/IIIa inhibitor tirofiban, early invasive coronary artery catheterization was superior to conservative coronary artery catheterization with respect to death, nonfatal MI, or rehospitalization for an acute coronary syndrome at 6 months. Reference 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 Jun 21;344(25):1879-87. Open reference URL https://web.pathway.md/studies/recUqX5D50AlMsnZn 2/2