A study in the September 2 issue of JAMA says that for some patients with acute coronary syndromes, the strategy of immediate intervention at a medical center does not appear to result in differences in outcomes in comparison with an intervention performed the next working day.
"The optimal intervention in the treatment strategy of patients presenting with acute coronary syndromes without ST-segment elevation (NSTE-ACS) has been debated for years," the authors write in background information for the study. "Numerous studies, randomized trials, and meta-analyses have investigated the potential benefits of invasive over conservative strategies, and most have suggested a prolonged advantage of an invasive approach for the prevention of death of myocardial infarction [MI; heart attack], particularly among high-risk patients."
Gilles Montalescot, M.D., Ph.D., of the Institut de Cardiologie, Centre Hospitalier Universitaire Pitie-Sapetriere, Paris, and colleagues from The Angioplasty to Blunt the Rise of Troponin in Acute Coronary Syndromes Randomized for an Immediate or Delayed Intervention (ABOARD) study evaluated data from 352 patients with acute coronary syndromes at 13 high-volume medical centers in France with 24-hour facilities for treatment of primary percutaneous coronary intervention (e.g, balloon angioplasty or stent placement) from August 2006 through September 2008. The patients, all of whom had acute coronary syndromes without ST-segment elevation (a certain pattern on the electrocardiogram [ECG]), were randomized to undergo an immediate invasive strategy or an invasive strategy scheduled on the next working day. The primary end point was the peak troponin value (biomarker indicating heart muscle involvement or damage) during hospitalization. The key secondary end point was the composite of death, myocardial infarction, or urgent revascularization at one-month follow-up.
"This study demonstrates the feasibility of immediate catheterization and revascularization in patients who present with NTSE-ACS but does not show that this strategy is superior to catheterization scheduled on the next working day," the authors write. "Thus, rapid or urgent catheterization appears preferable in high-risk or unstable patients, while the benefit in other situations may be limited to practicality and length of hospital stay," the authors conclude.