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Treatment and outcomes of patients with evolving myocardial infarction: experiences from the SYNERGY trial.

Abstract：

AIMS:Patients with myocardial infarction (MI) presenting immediately after symptom onset may be treated less aggressively due to their non-elevated troponin status. We compared the initial treatment and clinical outcomes of patients presenting with evolving MI (EMI) with those presenting with MI. METHODS AND RESULTS:This study analysed data from the Superior Yield of the New strategy of Enoxaparin, Revascularisation, and Glycoprotein IIb/IIIa inhibitors (SYNERGY) trial, which enrolled patients meeting at least two of the following: age >or= 60 years, elevated cardiac biomarkers, or ST-segment changes. Patients were stratified by troponin results obtained within 12 h of presentation: EMI [initial troponin (-), second troponin (+)], MI [initial troponin (+)], and no MI at enrolment [first and second troponin (-)]. Comparisons were made using Wilcoxon rank-sum and chi(2) tests. Of the 8,309 patients with complete data, 5,503 (66%) had MI, 1,686 (20%) had EMI, and 1,120 (13%) had no MI. Treatment patterns prior to enrolment were similar among EMI and MI patients [aspirin (88 vs. 86%), beta-blockers (62 vs. 61%), heparin (83 vs. 81%), and glycoprotein IIb/IIIa inhibitors (23 vs. 24%)]. Similar rates of percutaneous coronary intervention (48 vs. 50%) and coronary artery bypass grafting (21 vs. 22%) were seen after enrolment. Patients presenting with MI had a higher rate of death or recurrent MI compared with patients with EMI [16 vs. 13%, adjusted OR 1.22 (95% CI 1.04, 1.44)]. CONCLUSION:Initial treatment patterns were similar among patients with EMI and MI in the SYNERGY trial. Patients with EMI had lower rates of death or re-infarction at 30 days compared with patients presenting with positive troponin results.

journal_name

Eur Heart J

journal_title

European heart journal

authors

Miller CD,Banerjee A,Mahaffey KW,Kontos MC,Fermann G,Pollack CV Jr,Antman E,Aylward P,Goodman SG,Santos R,Ferguson JJ,Califf RM,Hoekstra JW

doi

10.1093/eurheartj/ehm016

subject

Has Abstract

pub_date

2007-05-01 00:00:00

pages

1079-84

issue

9

eissn

0195-668X

issn

1522-9645

pii

ehm016

journal_volume

28

pub_type

杂志文章,多中心研究,随机对照试验

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