Immediate vs Delayed Intervention for Acute Coronary Syndromes
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
- 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.
Abstract
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
