A to Z TIMI 21

OBJECTIVES

To determine if early aggressive treatment with simvastatin compared to standard therapy reduces major cardiac events at 1 year in high-risk acute coronary syndrome patients.

To determine the safety and efficacy of enoxaparin compared to unfractionated heparin when given to patients with acute coroanry syndromes also receiving the GP IIb/IIIa inhibitor tirofiban.

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1. The A-to-Z Trial: Methods and rationale for a single trial investigating combined use of low-molecular-weight heparin with the glycoprotein IIb/IIIa inhibitor tirofiban and defining the efficacy of early aggressive simvastatin therapy. Blazing MA, De Lemos JA, Dyke CK, Califf RM, Bilheimer D, Braunwald E. Am Heart J 2001;142:211-7.
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2. Safety and efficacy of enoxaparin vs unfractionated heparin in patients with non-ST-segment elevation acute coronary syndromes who receive tirofiban and aspirin: a randomized controlled trial. Blazing MA, de Lemos JA, White HD, et al. JAMA 2004;292:55-64.
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3. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial. de Lemos JA, Blazing MA, Wiviott SD, et al. JAMA 2004;292:1307-16.
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4. Enoxaparin versus unfractionated heparin in patients treated with tirofiban, aspirin and an early conservative initial management strategy: results from the A phase of the A-to-Z trial. de Lemos JA, Blazing MA, Wiviott SD, et al. Eur Heart J 2004;25:1688-94.
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5. Prognostic value of serial B-type natriuretic peptide testing during follow-up of patients with unstable coronary artery disease. Morrow DA, de Lemos JA, Blazing MA, et al. JAMA 2005;294:2866-71.
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6. Clinical relevance of C-reactive protein during follow-up of patients with acute coronary syndromes in the Aggrastat-to-Zocor Trial. Morrow DA, de Lemos JA, Sabatine MS, et al. Circulation 2006;114:281-8.
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7. Serial measurement of monocyte chemoattractant protein-1 after acute coronary syndromes: results from the A to Z trial. de Lemos JA, Morrow DA, Blazing MA, et al. J Am Coll Cardiol 2007;50:2117-24.
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