Outcome of patients with acute coronary syndrome admitted to hospitals with or without onsite cardiac catheterization laboratory: a TACTICS-TIMI 18 substudy.

In the TACTICS-TIMI-18 trial, patients with acute coronary syndrome were treated with aspirin, heparin, and tirofiban and were randomized to an invasive strategy with routine catheterization or to a conservative strategy with catheterization (only if the patient had objective evidence of ischemia). Eighty-two of 2,220 patients were treated in 13 peripheral hospitals without an onsite catheterization laboratory. Tirofiban was administered to the peripheral hospital group (which was treated invasively) for 28.4 hours before coronary angiography, compared with 20.6 hours in the tertiary center group (P = 0.01). There is a similar trend in outcomes with benefit of invasive therapy among patients treated in peripheral and tertiary hospitals, without increase risk of major bleeding.