329 Is there an optimal time for catheterization in NSTE-ACS patients with renal failure? Insights from the ABOARD Study (ABOARD: Angioplasty to Blunt the rise Of troponin in Acute coronary syndrome Ran)

Aim Whether timing of catheterization (immediate versus delayed intervention) in high risk ACS has an impact on outcome in patients with RF is not known. Methods In the randomized ABOARD study we showed that in patients with NSTE-ACS, a “primary PCI” strategy compared with a strategy of intervention deferred to the next working day did not result in a difference of clinical outcome. We compared these two strategies according to the renal status at 1-month follow-up. Severe RF was defined by a Creatinin Clearance (CrCl) 30 ml/min and moderate RF by a CrCl >30 and 60 ml/min. Results Eight (2.3%) patients had severe RF, 67 (19.4%) moderate RF and 270 (78.3%) no RF. Baseline characteristics were well matched except for a lower multivessel disease rate in the “primary PCI” strategy group (52% vs 85%, p = 0.008) in the moderate RF group. Patients received intense antiplatelet therapy with a mean 660 mg (± 268) clopidogrel loading dose followed by a 111 mg (± 40) maintenance dose, while 99% of the PCI patients received abciximab. LMWH were used in 68% of patients and radial approach was predominant (84%). The mean peak of troponin did not differ according to the revascularization strategy wathever the renal function. The 30-day rate of death, MI and urgent revascularization were higher in RF patients but did not differ significantly between the two revascularization strategies whatever the renal function. Recurrent ischemia was however significantly more frequent in the moderate RF group undergoing deferred catheterization in comparison with a primary PCI strategy (33,3% vs. 8.8%, p = 0.014). Major bleeding complications were similar whatever the strategy in the different renal function groups. Conclusion Although renal failure is associated with more ischemic complications, the timing of intervention appears to have no impact on outcome of these patients. Thus, the primary results of the ABOARD study apply also to renal failure patients.