title: Immediate vs delayed intervention for acute coronary syndromes: a randomized clinical trial.
abstract: 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.
authors.affiliation: Institut de Cardiologie, Bureau 2-236, Centre Hospitalier Universitaire Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France. gilles.montalescot@psl.aphp.fr
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cayla
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.forename: Simon
authors.initials: S
authors.lastname: Elhadad
authors.forename: Farzin
authors.initials: F
authors.lastname: Beygui
authors.forename: Hervé
authors.initials: H
authors.lastname: Le Breton
authors.forename: Rémi
authors.initials: R
authors.lastname: Choussat
authors.forename: Florence
authors.initials: F
authors.lastname: Leclercq
authors.forename: Johanne
authors.initials: J
authors.lastname: Silvain
authors.forename: François
authors.initials: F
authors.lastname: Duclos
authors.forename: Mounir
authors.initials: M
authors.lastname: Aout
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Dubois-Randé
authors.forename: Olivier
authors.initials: O
authors.lastname: Barthélémy
authors.forename: Grégory
authors.initials: G
authors.lastname: Ducrocq
authors.forename: Anne
authors.initials: A
authors.lastname: Bellemain-Appaix
authors.forename: Laurent
authors.initials: L
authors.lastname: Payot
authors.forename: Philippe-Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Patrick
authors.initials: P
authors.lastname: Henry
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
mesh_terms: 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
chemical_list: D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D007140:Immunoglobulin Fab Fragments; D014336:Troponin; D000077284:Abciximab