Montalescot G, Cayla G, Collet J-P, Elhadad S, Beygui F, Le Breton H, Choussat R, Leclercq F, Silvain J, Duclos F, Aout M, Dubois-Randé J-L, Barthélémy O, Ducrocq G, Bellemain-Appaix A, Payot L, Steg P-G, Henry P, Spaulding C, Vicaut E

Immediate vs delayed intervention for acute coronary syndromes. A randomized clinical trial

JAMA 2009;302:947–54

Acute coronary syndromes

To compare the effects of immediate vs delayed invasive strategies in reducing MI in patients with non-ST-segment elevation acute coronary syndromes

Randomised

1 month

352 patients (175 immediate intervention, 177 delayed intervention), mean age 65 ± 12 years, with a non-ST-segment elevation acute coronary syndrome and TIMI score ≥ 3

Immediate intervention or intervention 8–60 h after enrolment. Choice of PCI or CABG at the discretion of the physician

Antithrombotics, anticoagulants, ASA, clopidogrel, beta-blockers, statins and ACE inhibitors. Abciximab in patients undergoing PCI

The primary endpoint of peak troponin I value during hospitalisation was 2.1 ng/ml (interquartile range 0.3–7.1) in the immediate-intervention group and 1.7 ng/ml (interquartile range 0.3–7.2) in the delayed-intervention group (p = 0.70). There was no significant difference between the groups in the incidence of the secondary endpoint of death, MI or urgent revascularisation (13.7% vs 10.2%; p = 0.31)