Nevertheless, refractory is- chemia was reduced by an early approach, as were the risks of death, MI, and stroke among patients at the highest tertile of ischemic risk as defined by the GRACE risk score.107 To assess whether a more aggressive strategy of very early intervention, analogous to the standard of primary PCI for STEMI, would lead to improved outcomes in patients with non ST-elevation ACS, the ABOARD (Angioplasty to Blunt the Rise of Troponin in Acute Coronary Syndromes) study investigators123 compared angiography and intervention per- formed immediately on presentation with intervention carried out on the next working day. A total of 352 patients with unstable ischemic symptoms, ECG changes, or troponin elevation were randomized at 13 hospitals to immediate (at a median 70 minutes after enrollment) versus delayed (at a median 21 hours) angiography and revascularization. Back- ground antithrombotic therapy consisted of aspirin, clopi- dogrel with a loading dose of 300 mg, abciximab during PCI, and the anticoagulant of the investigator s choice. The primary trial endpoint was peak troponin I value during the hospitalization period. 