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NSTEMI: when to get ABOARD
For patients with non-ST-elevation myocardial infarction (NSTEMI), an invasive strategy is currently recommended; however, the optimal timing of coronary angiography and intervention is not known. Whereas the ISAR–COOL study showed that early angiography was superior to delayed angiography, the subsequent TIMACS study found that this only applied to high-risk patients.
The Angioplasty to Blunt the Rise of Troponin in Acute Coronary Syndromes Randomised for an Immediate or Delayed Intervention (ABOARD) study randomly assigned 352 NSTEMI patients with a TIMI score of more than 3 to either immediate intervention or intervention on the next working day (8–60 h after enrollment). The primary trial endpoint was the peak troponin value during hospitalisation, and the main secondary endpoint was the composite of death, myocardial infarction, or urgent revascularisation at 1-month follow-up.
In the immediate intervention group, the time from randomisation to sheath insertion was 70 minutes, compared with 21 h in the delayed intervention group. The median troponin I value was 2.1 in the immediate intervention group, compared with 1.7 in the delayed intervention group (p = 0.70), thus no significant difference was seen between the two treatment strategies in terms of the primary outcome. Similarly, no difference was the seen in the main secondary endpoint (p = 0.31), nor major bleeding, although immediate intervention was associated with a shorter hospital stay.
Immediate intervention in patients with NSTEMI shows no clear clinical advantage over a strategy of performing the procedure on the next working day; however, this study establishes that it is safe to do so if required.
▸ Montalescot G, Cayla G, Collet J-P, et al. Immediate vs delayed intervention …
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