TIMACS trial (2009) [19] | UA & NSTEMI | Multi-center trial with enrollment of 3031 patients selected based on eligibility criteria (two out of three) of age >60 years, ST segment changes in EKG and raised cardiac biomarker | Early intervention (PCI ≤ 24 hours after randomization) or delayed intervention (PCI ≥ 36 hours after randomization) | The primary outcome was a composite of death, MI or stroke at 6 months. Secondary outcome was death, myocardial infarction, or refractory ischemia at 6 months. | The reduction in the primary outcome was not significantly different between the two groups (p = 0.15). There was a relative reduction of 28% of secondary outcome in early intervention group compared to delayed intervention (p = 0.003) especially in high-risk patients. | Early intervention was better to delayed intervention in reducing the rate of secondary outcome of death, MI or refractory ischemia especially in high-risk patients. |
OPTIMA trial (2009) [20] | NSTEMI | Multi-center trial conducted in 3 high-volume centers with PCI facilities. 14 2 patients >21 years of age with no contraindication to PCI and fulfilling one of the 4 criteria’s including raised troponin T, ST depression, CAD and risk factor for CAD | Immediate PCI versus delayed PCI (24 to 48 hours) | The primary endpoint was a composite of death, non-fatal MI or unplanned revascularization, at 30 days. Following discharge patients were followed up at 30 days and 6 months. | At 30 days, the incidence of primary endpoint was 60% in group with immediate PCI compared to 39% in group receiving delayed PCI (p = 0.004). The incidence of MI was significantly higher in the group with immediate PCI (p = 0.005). The observed difference at the end of 30 days was preserved at 6-months’ follow-up. | PCI for high-risk patients with NSTEMI should be delayed for at least 24 h after hospital admission |
ABOARD trial (2009) [21] | NSTEMI | 352 patients with NSTEMI admitted at 13 high-volume centers in France. | Immediate invasive vs. invasive scheduled on the next working day, which means a time window of 8 - 60 hours post enrollment. Abciximab started in both cases before the start of PCI | The primary end point was peak troponin level during hospitalization. Secondary endpoint was the composite of death, MI or urgent revascularization at 1 month follow-up. | Both primary and secondary endpoints did not differ much between the two strategies | For patients with NSTEMI there is no difference in occurrence of MI when treated with immediate invasive vs. invasive therapy scheduled on the next day. |