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Intervention for Non–ST-Segment-Elevation Acute Coronary Syndromes: What Difference Does a Day Make?

Interventions performed immediately or deferred to the next working day resulted in similar outcomes.

The advantages of invasive over conservative strategies for managing non–ST-segment-elevation acute coronary syndromes (NSTEACS) are established, but the optimal timing of intervention is undetermined. To find out whether immediate catheterization compared with delayed intervention reduces incident MI, investigators in France randomized 352 patients hospitalized for NSTEACS to undergo interventional treatment either immediately upon admission or on the next working day (8–60 hours after enrollment).

Median time from randomization to sheath insertion was 70 minutes in the immediate-intervention group and 21 hours in the delayed-intervention group. The primary endpoint, peak troponin level during hospitalization, did not differ significantly between the two strategies (median peak levels, 2.1 ng/mL and 1.7 ng/mL in the immediate- and delayed-intervention groups, respectively). The rate of the composite of death, MI, and urgent revascularization at 1 month also did not differ significantly between the two groups (13.7% and 10.2%, respectively). However, median hospital stay was significantly shorter with the immediate strategy than with the delayed strategy (55 hours vs. 77 hours).

Comment: These findings suggest that in patients with non–ST-segment-elevation acute coronary syndromes, immediate versus delayed intervention does not result in increased MI rates, as defined by peak troponin levels. Accordingly, rapid or urgent intervention appears to be appropriate in unstable patients, whereas logistical and cost concerns may factor into decisions about whether to defer intervention in stable patients.

— Beat J. Meyer, MD

Published in Journal Watch Cardiology September 16, 2009

Citation(s):

Montalescot G et al. Immediate vs delayed intervention for acute coronary syndromes: A randomized clinical trial. JAMA 2009 Sep 2; 302:947.

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• Cell Death And Therapy
  Louis Zrebiec, Ph.D., Retired, 18 Sep 2009 9:07 AM EST
  Dear Dr. Gilles Montalescot , Ph.D.
  
  I found your study on myocardial infraction very interesting. Your study precludes any use... [more]