- Question
- Is a routine early invasive strategy superior to a conservative strategy in patients with unstable angina or non-ST-elevation myocardial infarction treated with tirofiban?
- Design
- Randomized trial of 2220 patients; all received background antithrombotic therapy and were assigned to one of two strategies, with follow-up at six months.
- Population
- Patients with unstable angina or non-ST-elevation myocardial infarction with ST-segment or T-wave changes on ECG, elevated cardiac markers, a history of coronary artery disease, or a combination of these findings.
- Intervention
- Early invasive strategy: routine catheterization within 4 to 48 hours and revascularization as appropriate, together with aspirin, heparin and tirofiban.
- Control
- Conservative (selectively invasive) strategy: catheterization only with objective evidence of recurrent ischemia or an abnormal stress test, with the same background therapy (aspirin, heparin and tirofiban).
- Primary outcome
- Composite of death, nonfatal myocardial infarction and rehospitalization for acute coronary syndrome at six months.
- Results
- The primary endpoint occurred in 15.9% with the early invasive strategy and 19.4% with the conservative strategy (odds ratio 0.78; 95% CI 0.62 to 0.97; P=0.025). Death or nonfatal myocardial infarction at six months was also reduced (7.3% vs. 9.5%; odds ratio 0.74; 95% CI 0.54 to 1.00; P<0.05).
- Conclusion
- In patients with unstable angina or non-ST-elevation myocardial infarction treated with tirofiban, an early invasive strategy significantly reduced major cardiac events.
- Why it matters
- It supported an early invasive strategy combined with early glycoprotein IIb/IIIa inhibition in these patients and helped shift practice away from a conservative approach.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 10, 2026