TIMACS
Trial question
What is the role of early invasive intervention in patients with acute coronary syndromes?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
35.0% female
65.0% male
N = 3031
3031 patients (1050 female, 1981 male).
Inclusion criteria: patients with acute coronary syndromes.
Key exclusion criteria: not a suitable candidate for coronary revascularization, comorbidity with life expectancy < 6 months, or age < 21 years.
Interventions
N=1593 early intervention (coronary angiography ≤ 24 hours after randomization).
N=1438 delayed intervention (coronary angiography ≥ 36 hours after randomization).
Primary outcome
Death, MI, or stroke at 6 months
9.6%
11.3%
11.3 %
8.5 %
5.7 %
2.8 %
0.0 %
Early
intervention
Delayed
intervention
No significant
difference ↔
No significant difference in death, MI, or stroke at 6 months (9.6% vs. 11.3%; HR 0.85, 95% CI 0.68 to 1.06).
Secondary outcomes
Significant decrease in death, MI, or refractory ischemia at 6 months (9.5% vs. 12.9%; HR 0.72, 95% CI 0.58 to 0.89).
Significant decrease in death, MI, or refractory ischemia at 6 months in high-risk patients (13.9% vs. 21%; HR 0.65, 95% CI 0.48 to 0.89).
No significant difference in death, MI, or refractory ischemia at 6 months in low-to-intermediate risk patients (7.6% vs. 6.7%; HR 1.12, 95% CI 0.81 to 1.56).
Safety outcomes
No significant differences in major bleeding, ICH, need for surgical intervention to stop bleeding, or retroperitoneal hemorrhage.
Conclusion
In patients with acute coronary syndromes, early intervention was not superior to delayed intervention with respect to death, MI, or stroke at 6 months.
Reference
Mehta SR, Granger CB, Boden WE et al. Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med. 2009 May 21;360(21):2165-75.
Open reference URL