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ABOARD: Immediate PCI yielded similar outcomes to delayed PCI in non-ST segment elevation ACS
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Patients undergoing immediate percutaneous coronary intervention in the setting of non-ST segment elevation acute coronary syndromes had similar outcomes to those who received delayed intervention, in a recent trial.
Researchers for the ABOARD study enrolled 352 patients with non-STEMI ACS and randomly assigned them to receive either immediate PCI (n=175) or next-day PCI (n=177). The median time from assignment to sheath insertion was 1.2 hours in the immediate PCI group and 20.5 hours in the delayed PCI group. The primary outcome was MI (defined as a peak in troponin I during hospitalization).
There was no difference in the peak troponin I values in patients who underwent immediate PCI compared with those who underwent delayed PCI (median of 2.1 vs. 1.7; P=.70). Among patients in the delayed PCI group, there was a trend toward increased rates of major bleeding (6.8% vs. 4.0%; P=.25) and thrombocytopenia (4.5% vs. 2.9%; P=.41) at one month. Patients who underwent immediate PCI had a shorter hospitalization compared with those who underwent delayed PCI (median 55 hours vs. 77 hours; P<.001).
“The primary PCI strategy in non-STEMI ACS compared with rapid intervention on the next day is feasible but does not reduce the risk for MI, [it] is not associated with significant differences in efficacy or other safety outcomes, and [it] does not benefit a particular group of patients,” Gilles Montalescot, MD, PhD, a professor of cardiology at Pitié-Salpêtrière Hospital in Paris, said in a presentation at the American College of Cardiology’s 58th Annual Scientific Sessions. “It does, however, shorten hospital stay significantly.” – by Eric Raible
For more information:
- Montalescot G. #2412. Presented at: American College of Cardiology’s 58th Annual Scientific Session; March 29-31, 2009; Orlando, Fla.
This may not be a trial of primary angioplasty for non-STEMI but rather may be a trial for facilitated PCI where there was excellent medical therapy given, and the corollary for STEMI might be appropriate to consider. It may be that immediate catheterization is associated with a slight excess of ischemic events not adequately measured in this underpowered trial, and we are better off doing same-day angioplasty three or four hours later when there has been adequate medical therapy on board at peak levels to decrease the risk for periprocedural complications.
– Eric R. Bates, MD
Professor of Internal Medicine, University of Michigan Cardiovascular Center, Ann Arbor