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.