Results of the Treat Angina With Aggrastat and Determine the Cost of Therapy With an Invasive or Conservative Strategy (TACTICS-TIMI 18) Trial: A Comparison of Invasive Versus Conservative Strategy in Patients With Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction
Bibliographic record
Abstract
Background: In the treatment of patients with unstable angina and non-ST segment elevation myocardial infarction (UA/NSTEMI), debate exists as to whether an early invasive vs. a conservative strategy is optimal therapy.Methods: In the international TACTICS-TIMI 18 trial, 2220 patients with UA/NSTEMI who had either electrocardiographic changes, elevated cardiac markers or a history of prior coronary artery disease, were immediately treated with aspirin, heparin and the glycoprotein (GP) IIb/IIIa inhibitor tirofiban.They were randomized to an early invasive strategy with routine catheterization and revascularization as appropriate within 4 -48 hours, or to a conservative, or "selective invasive" strategy, with catheterization performed only if the patient had objective evidence of recurrent ischemia or a positive stress test.The primary endpoint was a composite of death, myocardial infarction or rehospitalization for acute coronary syndromes at 6 months.Results: The rate of the primary endpoint was significantly reduced with the invasive strategy compared to the conservative strategy, 15.9% vs. 19.4%,odds ratio (OR) 0.78, pϭ0.025.The rate of death or MI at 6 months was also significantly reduced (9.5% vs. 7.3%, respectively, OR 0.74, pϽ0.05).Conclusion: In patients with UA/NSTEMI treated with the GP IIb/IIIa inhibitor tirofiban, an early invasive strategy resulted in a significant reduction in major cardiac events.These data suggest a need to update the ACC/AHA Unstable angina Guidelines, and to modify the clinical approach to managing unstable angina with broader use of an early invasive strategy with upstream GP IIb/IIIa inhibition. Effect of the Angiotensin Receptor Blocker Valsartan on Morbidity and Mortality in HeartFailure: the Valsartan Heart Failure Trial (Val-HeFT) Jay N. Cohn and Gianni Tognoni for the Val-HeFT Investigators, Minneapolis, Minnesota and Milan, ItalyIn order to assess the efficacy of the angiotensin receptor blocker valsartan in the treatment of heart failure (HF), 5010 patients were studied in 16 countries on 4 continents.Patients with chronic HF [NYHA II (62%), III (36%) and IV (2%)], ejection fraction (EF) Ͻ40% and left ventricular diastolic transverse diameter (LVIDD) Ͼ2.9 cm/m2 were randomly assigned to receive placebo (P) or valsartan (V) (titrated to 160 mg BID) in addition to all other appropriate therapy including ACE inhibitors (93%), beta blockers (36%), diuretics (86%) and digoxin (67%).Primary end-points were all-cause mortality (M) and mortality plus morbidity (MϩM), which included hospitalization for heart failure (adjudicated), cardiac arrest with resuscitation, or need for intravenous support for worsening heart failure.Time to death was similar in the two groups but time to first MϩM event was significantly reduced by 13.3% by V (32.1% in P, 28.8% in V; Pϭ0.009).HF hospitalization was significantly reduced by 27.5% by V (18.5% in P, 13.9% in V; (PϽ0.001).The benefit of V on MϩM was particularly prominent in patients not taking a beta blocker (37.0% to 30.8%, PϽ0.001) and in those not taking an ACE inhibitor (42.5% to 24.9%, PϽ0.001).The benefit on MϩM was accompanied by significant improvements in NYHA class, quality of life, and EF.These data demonstrate clinical efficacy of valsartan in heart failure in patients already receiving standard HF therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".