Design

• Multicenter, parallel-group study, enrolled 2220 patients with acute coronary syndromes (ACS) and unstable angina or non–Q-wave/non–ST-elevation (NSTE) myocardial infarction (MI) in the previous 24 hours.
• All patients received AGGRASTAT (0.4 µg/kg/min for 30 minutes followed by 0.1 µg/kg/min infusion), acetylsalicylic acid (ASA), and heparin followed by randomization to either an early invasive strategy (coronary angiography between four and 48 hours after randomization and revascularization when appropriate) or an early conservative strategy (medical treatment followed by coronary angiography only for objective evidence of ischemia or abnormal stress test).
• The primary endpoint was a composite of death, MI, or rehospitalization for ACS at six months.

Results

• Incidence of the primary endpoint was 15.9% with early invasive strategy and 19.4% with early conservative strategy (22% risk reduction, p=0.025).
• Bleeding occurred in 5.5% of the patients in the invasive strategy group, as compared with 3.3% of those in the conservative strategy group (p<0.01), but the rates of major bleeding were not significantly different (1.9% vs. 1.3%, p=0.24).

Conclusion

• In patients with unstable angina and NSTE MI who were treated with AGGRASTAT, the use of an early invasive strategy significantly reduced the incidence of major cardiac events at 30 days (p=0.009) and six months (p=0.025).

In TACTICS, among all patients with ACS and unstable angina or non–Q-wave/NSTE MI who received AGGRASTAT, ASA, and heparin, those who underwent an early invasive treatment strategy showed a significantly lower risk of death, MI, refractory ischemia, and rehospitalization for unstable angina at 30 days (p=0.009) and six months (p=0.025) than those who underwent an early conservative treatment strategy.
Adapted from Cannon et al.³