A to Z-(TIMI 21) evaluated if early aggressive treatment with simvastatin compared to standard therapy reduces major cardiac events at 1 year in high-risk acute coronary syndrome patients. TIMI 21 also evaluated the safety and efficacy of enoxaparin compared to unfractionated heparin when given to patients with acute coronary syndromes also receiving the GP IIb/IIIa inhibitor tirofiban.

Screenshot_2021-02-03 No Slide Title - timi-21-slides pdf

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

Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial

JAMA. 2004 Jul 7;292(1):55-64.
JAMA. 2004 Sep 15;292(11):1307-16.


TIMI 21 Slides


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. Am Heart J. 2001 Aug;142(2):211-7.

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. Eur Heart J. 2004 Oct;25(19):1688-94.

Prognostic value of serial B-type natriuretic peptide testing during follow-up of patients with unstable coronary artery disease. JAMA. 2005 Dec 14;294(22):2866-71.

A tale of two trials: a comparison of the post-acute coronary syndrome lipid-lowering trials A to Z and PROVE IT-TIMI 22. Circulation. 2006 Mar 21;113(11):1406-14.

Clinical relevance of C-reactive protein during follow-up of patients with acute coronary syndromes in the Aggrastat-to-Zocor Trial. Circulation. 2006 Jul 25;114(4):281-8.

Evaluation of the National Cholesterol Education Program Adult Treatment Panel III algorithm for selecting candidates for statin therapy: insights from the A to Z trial. Am J Cardiol. 2006 Sep 15;98(6):739-42.

The safety and efficacy of achieving very low LDL-cholesterol concentrations with high dose statin therapy. Curr Opin Lipidol. 2006 Dec;17(6):626-30.

Serial measurement of monocyte chemoattractant protein-1 after acute coronary syndromes: results from the A to Z trial. J Am Coll Cardiol. 2007 Nov 27;50(22):2117-24.

Outcomes of patients with acute coronary syndrome and previous coronary artery bypass grafting (from the Pravastatin or Atorvastatin Evaluation and Infection Therapy [PROVE IT-TIMI 22] and the Aggrastat to Zocor [A to Z] trials). Am J Cardiol. 2008 Sep 1;102(5):552-8.

Prior aspirin use and outcomes in acute coronary syndromes. J Am Coll Cardiol. 2010 Oct 19;56(17):1376-85.

Association Between Lowering LDL-C and Cardiovascular Risk Reduction Among Different Therapeutic Interventions: A Systematic Review and Meta-analysis. JAMA. 2016 Sep 27;316(12):1289-97.

Association Between Triglyceride Lowering and Reduction of Cardiovascular Risk Across Multiple Lipid-Lowering Therapeutic Classes: A Systematic Review and Meta-Regression Analysis of Randomized Controlled Trials. Circulation. 2019 Oct 15;140(16):1308-1317.

Outcomes of Women Compared With Men After Non-ST-Segment Elevation Acute Coronary Syndromes. J Am Coll Cardiol. 2019 Dec 17;74(24):3013-3022.

Growth differentiation factor 15 and cardiovascular risk: individual patient meta-analysis. Eur Heart J. 2023 Jan 21;44(4):293-300.

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