1. Singh Joy, Subhashni D.
  2. Kayyali, Andrea MSN, RN

According to this study:

* No difference was detected in peak troponin I levels with early PCI, compared with intervention a day later.


* There were also no differences in rates of death, MI, or the need for urgent revascularization.



Article Content

How quickly treatment is initiated plays a crucial role in organ preservation in many acute ischemic conditions. Researchers sought to test this principle with percutaneous coronary intervention (PCI) in cases of acute coronary syndromes without ST-segment elevation. The randomized clinical trial measured peak troponin I levels (troponin is a biomarker for cardiac injury) in patients who underwent a PCI either immediately (within hours) or the next working day (which, if enrollment occurred on a weekend, was the next Monday), to determine whether the severity of myocardial infarction (MI) damage would be lower with immediate treatment. Secondary outcomes-death, MI, and the need for acute revascularization-were evaluated one month after surgery.


Thirteen institutions with PCI capabilities in France participated in the trial, recruiting 352 eligible patients to receive either immediate (n = 175) or delayed (eight to 60 hours after enrollment; n = 177) intervention. Baseline characteristics, in terms of comorbidities and hospital drug therapy were similar in the two groups. After randomization, patients in the immediate-intervention group had a median time of 70 minutes to sheath insertion. The delayed-intervention group's median time to insertion was 21 hours, equal to roughly a day after randomization.


Peak troponin I levels during hospitalization (the primary endpoint) didn't differ significantly between the two groups: the median troponin I level in the immediate-treatment group was 2.1 ng/mL, compared with 1.7 ng/mL in the delayed-treatment group. Analysis of secondary end points yielded comparable results: there were no significant differences in rates of death, MI, or urgent revascularization (when they were analyzed together or separately). Additionally, no difference was detected in bleeding episodes between the groups. These results led the researchers to conclude that the severity of MI wasn't lessened by immediate PCI in this subset of patients.


The only real difference the researchers found was in the length of hospital stay, which was significantly shorter in the immediate-intervention group.




Montalescot G, et al. JAMA 2009;302(9):947-54.