• Gilles Montalescot, Guillaume Cayla, Jean-Philippe Collet, Simon Elhadad, Farzin Beygui, Hervé Le Breton, Rémi Choussat, Florence Leclercq, Johanne Silvain, François Duclos, Mounir Aout, Jean-Luc Dubois-Randé, Olivier Barthélémy, Grégory Ducrocq, Anne Bellemain-Appaix, Laurent Payot, Philippe-Gabriel Steg, Patrick Henry, Christian Spaulding, Eric Vicaut, and ABOARD Investigators.
• Institut de Cardiologie, Bureau 2-236, Centre Hospitalier Universitaire Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France. gilles.montalescot@psl.aphp.fr
• JAMA. 2009 Sep 2; 302 (9): 947-54.

ContextInternational guidelines recommend an early invasive strategy for patients with high-risk acute coronary syndromes without ST-segment elevation, but the optimal timing of intervention is uncertain.ObjectiveTo determine whether immediate intervention on admission can result in a reduction of myocardial infarction compared with a delayed intervention.Design, Setting, And PatientsThe Angioplasty to Blunt the Rise of Troponin in Acute Coronary Syndromes Randomized for an Immediate or Delayed Intervention (ABOARD) study, a randomized clinical trial that assigned, from August 2006 through September 2008 at 13 centers in France, 352 patients with acute coronary syndromes without ST-segment elevation and a Thrombolysis in Myocardial Infarction (TIMI) score of 3 or more to receive intervention either immediately or on the next working day (between 8 and 60 hours after enrollment).Main Outcome MeasuresThe primary end point was the peak troponin value during hospitalization; the key secondary end point was the composite of death, myocardial infarction, or urgent revascularization at 1-month follow-up.ResultsTime from randomization to sheath insertion was 70 minutes with immediate intervention vs 21 hours with delayed intervention. The primary end point did not differ between the 2 strategies (median [interquartile range] troponin I value, 2.1 [0.3-7.1] ng/mL vs 1.7 [0.3-7.2] ng/mL in the immediate and delayed intervention groups, respectively; P = .70). The key secondary end point was observed in 13.7% (95% confidence interval, 8.6%-18.8%) of the group assigned to receive immediate intervention and 10.2% (95% confidence interval, 5.7%-14.6%) of the group assigned to receive delayed intervention (P = .31). The other end points, as well as major bleeding, did not differ between the 2 strategies.ConclusionIn patients with acute coronary syndromes without ST-segment elevation, a strategy of immediate intervention compared with a strategy of intervention deferred to the next working day (mean, 21 hours) did not result in a difference in myocardial infarction as defined by peak troponin level.Trial Registrationclinicaltrials.gov Identifier: NCT00442949.

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