Immediate vs delayed intervention for acute coronary syndromes: a randomized clinical trial.
BACKGROUND
International guidelines recommend an early invasive strategy for patients with high-risk acute coronary syndromes without ST-segment elevation, but the optimal timing of intervention is uncertain.


OBJECTIVE
To determine whether immediate intervention on admission can result in a reduction of myocardial infarction compared with a delayed intervention.


METHODS
The Angioplasty to Blunt the Rise of Troponin in Acute Coronary Syndromes Randomized for an Immediate or Delayed Intervention (ABOARD) study, a randomized clinical trial that assigned, from August 2006 through September 2008 at 13 centers in France, 352 patients with acute coronary syndromes without ST-segment elevation and a Thrombolysis in Myocardial Infarction (TIMI) score of 3 or more to receive intervention either immediately or on the next working day (between 8 and 60 hours after enrollment).


METHODS
The primary end point was the peak troponin value during hospitalization; the key secondary end point was the composite of death, myocardial infarction, or urgent revascularization at 1-month follow-up.


RESULTS
Time from randomization to sheath insertion was 70 minutes with immediate intervention vs 21 hours with delayed intervention. The primary end point did not differ between the 2 strategies (median [interquartile range] troponin I value, 2.1 [0.3-7.1] ng/mL vs 1.7 [0.3-7.2] ng/mL in the immediate and delayed intervention groups, respectively; P = .70). The key secondary end point was observed in 13.7% (95% confidence interval, 8.6%-18.8%) of the group assigned to receive immediate intervention and 10.2% (95% confidence interval, 5.7%-14.6%) of the group assigned to receive delayed intervention (P = .31). The other end points, as well as major bleeding, did not differ between the 2 strategies.


CONCLUSIONS
In patients with acute coronary syndromes without ST-segment elevation, a strategy of immediate intervention compared with a strategy of intervention deferred to the next working day (mean, 21 hours) did not result in a difference in myocardial infarction as defined by peak troponin level.


BACKGROUND
clinicaltrials.gov Identifier: NCT00442949.
Montalescot
Gilles
G
Institut de Cardiologie, Bureau 2-236, Centre Hospitalier Universitaire Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France. gilles.montalescot@psl.aphp.fr
Cayla
Guillaume
G
Collet
Jean-Philippe
JP
Elhadad
Simon
S
Beygui
Farzin
F
Le Breton
Hervé
H
Choussat
Rémi
R
Leclercq
Florence
F
Silvain
Johanne
J
Duclos
François
F
Aout
Mounir
M
Dubois-Randé
Jean-Luc
JL
Barthélémy
Olivier
O
Ducrocq
Grégory
G
Bellemain-Appaix
Anne
A
Payot
Laurent
L
Steg
Philippe-Gabriel
PG
Henry
Patrick
P
Spaulding
Christian
C
Vicaut
Eric
E
D000077284:Abciximab; D054058:Acute Coronary Syndrome / Q000097:blood / Q000401:mortality / Q000628:therapy*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D006328:Cardiac Catheterization; D001026:Coronary Artery Bypass; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality / Q000517:prevention & control; D010043:Outcome and Process Assessment, Health Care; D013997:Time Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D007140:Immunoglobulin Fab Fragments; D014336:Troponin; D000077284:Abciximab