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TIMACS: No harm from early intervention in patients with ACS

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Patients undergoing interventional therapy for the treatment of acute coronary syndromes were not harmed by early intervention.

Researchers for the TIMACS trial enrolled 3,031 patients with ACS who they randomly assigned to receive either early intervention with coronary angiography followed by either percutaneous coronary intervention or CABG (n=1,593), or angiography plus intervention delayed by at least 36 hours (n=1,438). The primary outcome was a composite of death, MI or stroke at six months.

According to the researchers, the occurrence of the primary outcome in the early intervention group was no different than in the delayed intervention group (9.6% vs. 11.3%; HR=0.85; 95% CI, 0.68-1.06). For the secondary endpoints of death, MI or refractory ischemia at six months, early intervention was beneficial (HR=0.72; 95% CI, 0.58-0.79). Patients who were classified as high-risk using the GRACE score (n=961) also had lower rates of death, MI or stroke vs. high-risk patients receiving delayed intervention (14.1% vs. 21.6%; HR=0.65; 95% CI, 0.48-0.89).

“Early intervention significantly reduced the risk of refractory ischemia and appeared to be superior to a delayed strategy in high-risk patients,” the researchers wrote in their conclusion.

In an editorial published with the study in the New England Journal of Medicine, L. Davis Hillis, MD, and Richard A. Lange, MD, stressed the importance of determining the patient’s risk for developing a cardiac ischemic event at the initial evaluation using either a TIMI score or GRACE score.

“The treatment of patients with ACS is optimal when the intensity of the therapy, both medical and nonmedical (coronary angiography and revascularization), is tailored to the patient’s risk of an ischemic cardiac event or a treatment-related complication,” the authors wrote. “In patients who are considered to be at high risk, optimal therapy results in substantial decrease in rates of MI and recurrent ischemia and a modest decrease in the rate of death.”

For more information:

• Mehta S. N Engl J Med. 2009;360:2165-2175.
• Hillis D. N Engl J Med. 2009;360:2237-2240.