Interpretation:

The authors concluded that in patients with UA/NSTEMI treated with a GP IIb/IIIa inhibitor, the clinical benefit of an early invasive strategy was achieved with a small increment in cost. The projected estimates of cost per year of life gained appear favorable with the invasive strategy. The authors suggest that these results support the broader use of an early invasive strategy in patients with acute coronary syndromes. This economic analysis of the TACTICS-TIMI 18 suggest that the benefit of an early invasive strategy in reducing major cardiac events is achieved with a small increase in overall cost, with favorable cost-effectiveness ratios after modeling the impact of the lower nonfatal MI rate over the long term. The results of the main trial had suggested that in patients without ST-segment changes or elevated troponin levels there were no significant reductions in either death or non fatal myocardial infarction. Therefore for obvious reasons, the conservative strategy may be the dominant strategy in low-risk individuals by being less expensive and equally effective. Overall, the results of this economic analysis strongly support the ACC/AHA acute coronary syndrome guidelines, which recommends an early invasive strategy for several high-risk subgroups presenting with acute coronary syndromes.