Trial (year) | Coronary events | Population | Treatment | Endpoints | Result | Conclusion |
TIMI-IIIB trial (1994) [4] | Unstable Angina (UA) | 1473 men and women; Age 21 - 79; have ECG changes of undocumented CAD | Early invasive (PCI) vs. early conservative therapy. PCI done within the first 6 weeks especially in the first 48 hours. | Composite of death, MI or abnormalities on an exercise stress test. | No significant difference in composite endpoint. Significant difference in length of initial hospitalization (p = 0.01), incidence or re hospitalization within 6 weeks (p < 0.001) and number of days of re-hospitalization (p < 0.001) | Either therapy is appropriate for patient management |
FRISC II trial (1999) [14] | NSTEMI | 2457 patients from 58 Scandinavian countries. | Early invasive versus early conservative treatment with placebo-controlled long-arm LMWH (deltaparin). Coronary angiography done within 7 days of randomization | Composite endpoint of death or MI. | After 6 months, the incidence of MI or death was significantly lower in early-invasive group (p = 0.03). Decrease in angina symptoms and hospital readmission. Highest benefit for the high-risk patients with ST depression in ECG and troponin T levels was at least 0.03 µg/L. At 5 years follow up the composite endpoints were lower in early invasive group (p = 0.009) | Short-term follow up shows early invasive therapy better than early conservative. The 5 years follow up showed sustained benefit of early invasive therapy in moderate to high-risk patients. |
TACTICS-TIMI 18 trial (2001) [4] | NSTEMI | 2220 patients aged 18 or more were randomly selected based on ST changes in ECG with raised cardiac biomarker. | Early-invasive treatment strategy (routine coronary angiography and if needed revascularization within 4 to 48 hours of hospital admission) versus a more conservative strategy (medical management and coronary angiography only in patients with spontaneous or inducible Ischemia). All patients received aspirin, heparin & tirofiban. | Composite of death, nonfatal MI, and re-hospitalization for ACS at 6 months | Primary end point is significantly lower in early invasive group (p = 0.025). Intervention superior if Troponin T positive (p < 0.001) and TIMI score > 3. | The benefits of the early-invasive strategy was greatest only in medium- and high-risk patients, with elevated cardiac troponin T levels and ECG demonstrating ST-segment change or a TIMI risk score of at least 3. In other cases there was not any significant difference between the groups. |