Current management of unstable angina: lessons from the TACTICS-TIMI 18 trial.
Patients presenting with unstable angina pectoris or non-Q-wave myocardial infarction (MI), if treated inadequately, are at a high risk of MI and subsequent mortality. The use of intravenous small molecule glycoprotein IIb/IIIa inhibitors along with standard therapeutic management options improves outcome. Since the publication of the Thrombolysis in Myocardial Ischemia IIIB, Veterans Affairs Non-Q-Wave Infarction Strategies In-Hospital (VANQWISH) and Fragmin and Fast Revascularization during InStability in Coronary artery disease II (FRISC II) studies, there is great debate about the advantages of following an early 'invasive' treatment option with coronary angiography and revascularization after initial medical therapy compared with the 'conservative' approach, where angiography is reserved for those who remain symptomatic. The Treat angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy--Thrombolysis in Myocardial Infarction 18 (TACTICS-TIMI 18) study has helped to resolve some of the controversies since it was designed with more current medical (early and routine use of tirofiban) and revascularization (use of stents during percutaneous coronary interventions) options as part of the invasive treatment protocol. This study indicated that an early invasive strategy in risk stratified patients combined with early use of tirofiban with standard medical therapy significantly improves outcome and appears well tolerated.
Manoharan
Ganesh
G
Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, Northern Ireland. gmanoharan@msn.com
Adgey
A A Jennifer
AA
D000789:Angina, Unstable / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D000800:Angioplasty, Balloon; D001241:Aspirin / Q000627:therapeutic use; D017985:Dalteparin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D015912:Thrombolytic Therapy; D000077466:Tirofiban; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D014443:Tyrosine; D006493:Heparin; D000077466:Tirofiban; D001241:Aspirin; D017985:Dalteparin