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A Randomized Clinical Trial

Gilles Montalescot, MD, PhD; Guillaume Cayla, MD; Jean-Philippe Collet, MD, PhD; Simon Elhadad, MD; Farzin Beygui, MD, PhD; Hervé Le Breton, MD; Rémi Choussat, MD; Florence Leclercq, MD; Johanne Silvain, MD; François Duclos, MD; Mounir Aout, PhD; Jean-Luc Dubois-Randé, MD; Olivier Barthélémy, MD; Grégory Ducrocq, MD; Anne Bellemain-Appaix, MD; Laurent Payot, MD; Philippe-Gabriel Steg, MD; Patrick Henry, MD; Christian Spaulding, MD; Eric Vicaut, MD, PhD; for the ABOARD Investigators

JAMA. 2009;302(9):947-954.

Context  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.

Design, Setting, and Patients  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).

Main Outcome Measures  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.

Conclusion  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.

Trial Registration  clinicaltrials.gov Identifier: NCT00442949

Author Affiliations: Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière (AP-HP), Université Paris 6, INSERM CMR 937, Paris (Drs Montalescot, Collet, Beygui, Choussat, Silvain, Barthélémy, and Bellemain-Appaix); Service de Cardiologie, Centre Hospitalier Universitaire Carémeau, Nîmes (Dr Cayla); Service de Cardiologie, Centre Hospitalier de Lagny–Marne la Vallée, Lagny-sur-Marne (Dr Elhadad); Service de Cardiologie et Maladies Vasculaires, INSERM U642, Université de Rennes 1, Centre Hospitalier Universitaire Rennes, Rennes (Dr Le Breton); Service de Cardiologie, Centre Hospitalier Universitaire Arnaud de Villeneuve, Montpellier (Dr Leclercq); Service de Cardiologie, Centre Hospitalier V. Dupouy, Argenteuil (Dr Duclos); Unité de Recherche Clinique (Drs Aout and Vicaut) and Service de Cardiologie (Dr Henry), Centre Hospitalier Universitaire Lariboisière (AP-HP), Université Paris, Paris; Service de Cardiologie, Centre Hospitalier Universitaire H. Mondor (AP-HP), Créteil (Drs Aout, Dubois-Randé, and Vicaut); INSERM U-698 and Service de Cardiologie, Centre Hospitalier Universitaire Bichat-Claude Bernard (AP-HP), Paris (Drs Ducrocq and Steg); Service de Cardiologie, Centre Hospitalier Intercommunal A. Grégoire, Montreuil-sous-Bois (Dr Payot); Service de Cardiologie, Centre Hospitalier Cochin (AP-HP), INSERM U909, Université Paris-Descartes, Paris (Dr Spaulding), France.

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