TIMACS Trial (2009): Early versus Delayed Invasive Intervention in ACS

2009, TIMACS trial: Early vs delayed invasive intervention in acute coronary syndrome, NEJM

TIMACS trial addressed the question of when to intervene in patients who come to hospital with unstable angina and/or NSTEMI. Although the results showed no benefits of early intervention but in subgroup analysis, the results were significantly in favor of performing early intervention in high risk patients (GRACE score> 140). The GRACE ACS score prognosticates patients with ACS and is a useful predictor of 6 months mortality.

The ABOARD and OPTIMA trial were done during the same year but these were smaller trials with limited study population compared to TIMACS trial. The FRISC II trial (1999) also showed benefits of early intervention within 7 days in terms of 5 year recurrence of MIs but the comparison was with patients who were treated with maximal medical therapy before intervention.

The 2014 ACC/AHA guidelines on NSTE-ACS recommends early invasive strategy (within 24 hours of admission) over a delayed invasive strategy (within 25 to 72 hours) for initially stabilized high-risk patients with NSTE-ACS.