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Cited by 2,103

The DOI matches its Crossref record; 1 of the 1 references it cites were found in a registry or an index.

Comparison of Early Invasive and Conservative Strategies in Patients with Unstable Coronary Syndromes Treated with the Glycoprotein IIb/IIIa Inhibitor Tirofiban

Open access
Cannon, Christopher P., Weintraub, William S., Demopoulos, Laura A., Vicari, Ralph, Frey, Martin J., Lakkis, Nasser, Neumann, Franz-Josef, Robertson, Debbie H., DeLucca, Paul T., DiBattiste, Peter M., Gibson, C. Michael, Braunwald, Eugene·2001·New England Journal of Medicine
DOI 10.1056/nejm200106213442501
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Abstract

BACKGROUND: There is continued debate as to whether a routine, early invasive strategy is superior to a conservative strategy for the management of unstable angina and myocardial infarction without ST-segment elevation. METHODS: We enrolled 2220 patients with unstable angina and myocardial infarction without ST-segment elevation who had electrocardiographic evidence of changes in the ST segment or T wave, elevated levels of cardiac markers, a history of coronary artery disease, or all three findings. All patients were treated with aspirin, heparin, and the glycoprotein IIb/IIIa inhibitor tirofiban. They were randomly assigned to an early invasive strategy, which included routine catheterization within 4 to 48 hours and revascularization as appropriate, or to a more conservative (selectively invasive) strategy, in which catheterization was performed only if the patient had objective evidence of recurrent ischemia or an abnormal stress test. The primary end point was a composite of death, nonfatal myocardial infarction, and rehospitalization for an acute coronary syndrome at six months. RESULTS: At six months, the rate of the primary end point was 15.9 percent with use of the early invasive strategy and 19.4 percent with use of the conservative strategy (odds ratio, 0.78; 95 percent confidence interval, 0.62 to 0.97; P=0.025). The rate of death or nonfatal myocardial infarction at six months was similarly reduced (7.3 percent vs. 9.5 percent; odds ratio, 0.74; 95 percent confidence interval, 0.54 to 1.00; P<0.05). CONCLUSIONS: In patients with unstable angina and myocardial infarction without ST-segment elevation who were treated with the glycoprotein IIb/IIIa inhibitor tirofiban, the use of an early invasive strategy significantly reduced the incidence of major cardiac events. These data support a policy involving broader use of the early inhibition of glycoprotein IIb/IIIa in combination with an early invasive strategy in such patients.

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Crossref · 10.1056/nejm200106213442501

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Metadata

Authors
Cannon, C. P., Weintraub, W. S., Demopoulos, L. A., Vicari, R., Frey, M. J., Lakkis, N., Neumann, F.-J., Robertson, D. H., DeLucca, P. T., DiBattiste, P. M., Gibson, C. M., & Braunwald, E.
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2001-06-21
Volume
344
Issue
25
Pages
1879-1887
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm200106213442501
OpenAlex
W2315322366
Cited by
2,103
References
1
FWCI
130.38
Type
journal article
Language
en
Open access
bronze

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