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.