Early versus Delayed Invasive Intervention in Acute Coronary Syndromes? TIMACS Study Review article
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Abstract
Earlier trials have shown that a routine invasive strategy improves outcomes in patients with acute coronary syndromes without ST-segment elevation. However, the optimal timing of such intervention remains uncertain. In the TIMACS study 3031 patients with acute coronary syndromes were randomized to undergo either routine early intervention or delayed intervention (coronary angiography ≥36 hours after randomization). The primary outcome was a composite of death, myocardial infarction, or stroke at 6 months. A prespecified secondary outcome was death, myocardial infarction, or refractory ischemia at 6 months. At 6 months follow-up, there was no difference in primary outcome of patients in the early-intervention group, as compared in the delayed-intervention group. There was a relative reduction of 28% in the secondary outcome of death, myocardial infarction, or refractory ischemia in the early-intervention group as compared with the delayed-intervention group. In most patients with ACS without ST-segment elevation, an early strategy did not differ from delayed-intervention strategy in preventing primary outcome. However early intervention significantly reduced the risk of refractory ischemia and appeared to be superior to a delayed strategy in high-risk patients. Routine early intervention may be preferred option when the access to the cathlab is available.
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References
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