Two anticoagulant therapies for treating acute coronary syndromes show similar outcomes at one year

High-risk patients with acute coronary syndromes (ACS) treated with an early revascularization strategy and enoxaparin or unfractionated heparin at the time of hospitalization for ACS had similar outcomes at one year, including remaining at substantial risk for adverse cardiovascular events, according to a study in the November 23/30 issue of JAMA.

Patients with nonST-segment elevation (NSTE - a certain pattern on an electrocardiogram) acute coronary syndromes (ACS) comprise a spectrum of risk for adverse cardiac events, according to background information in the article. In the Superior Yield of the New Strategy of Enoxaparin, Revascularization, and Glycoprotein IIb/IIIa Inhibitors (SYNERGY) trial, patients at high risk for recurrent ischemic cardiac events were randomly assigned to receive the anticoagulants low-molecular-weight heparin (enoxaparin) or unfractionated heparin. The primary results at 30 days showed that enoxaparin was at least as effective as unfractionated heparin in reducing death or nonfatal myocardial infarction (MI heart attack). The current study examines the results at six months and one year. "We believe this to be valuable, given the high-risk clinical characteristics of the patient population in SYNERGY and the need to understand the long-term outcomes in patients managed with an early aggressive invasive treatment strategy," the researchers write.

Kenneth W. Mahaffey, M.D., of Duke Clinical Research Institute, Durham, N.C., and colleagues analyzed follow-up data at 6 months and one year from the SYNERGY trial, which included 9,978 patients who were randomized from August 2001 through December 2003 in 487 hospitals in 12 countries. At six months, 541 patients (5.4 percent) had died, and 739 (7.4 percent) had died at one year. The researchers found that death or nonfatal MI at six months occurred in 872 patients receiving enoxaparin (17.6 percent) vs. 884 receiving unfractionated (not separated) heparin (17.8 percent). Reh

Contact: Richard Merritt
JAMA and Archives Journals

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