Immediate intervention compared with delayed intervention did not result in a difference in peak troponin level (median 2.1 vs 1.7 ng/mL; P=.70) in patients with NSTE-ACS.
RCT (n=352)
randomized
Yes
Does immediate intervention reduce peak troponin values in patients with acute coronary syndromes without ST-segment elevation compared to delayed intervention?
In patients with high-risk NSTE-ACS, an immediate invasive strategy does not reduce myocardial infarction size (measured by peak troponin) compared to a delayed strategy performed on the next working day.
Absolute Event Rate: 2.1% vs 1.7%
p-value: p=.70
ContextInternational 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.ObjectiveTo determine whether immediate intervention on admission can result in a reduction of myocardial infarction compared with a delayed intervention.Design, Setting, and PatientsThe 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).Main Outcome MeasuresThe 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.ResultsTime 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.ConclusionIn 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.Trial Registrationclinicaltrials.gov Identifier: NCT00442949
Montalescot et al. (Tue,) conducted a rct in acute coronary syndromes without ST-segment elevation (n=352). Immediate intervention vs. Delayed intervention (next working day) was evaluated on Peak troponin value during hospitalization (p=.70). Immediate intervention compared with delayed intervention did not result in a difference in peak troponin level (median 2.1 vs 1.7 ng/mL; P=.70) in patients with NSTE-ACS.