Comparison of effectiveness of enoxaparin versus unfractionated heparin to reduce silent and clinically apparent acute myocardial infarction in patients presenting with non-ST-segment elevation acute coronary syndrome.
Journal Article (Journal Article;Multicenter Study)
Electrocardiographic (ECG) estimates of myocardial infarct size based on the Selvester ECG score have been shown to predict mortality and left ventricular function after acute myocardial infarction (AMI). This score has also been used to identify not clinically apparent AMI ("silent" AMI) and to determine treatment effect, suggesting it could serve as a clinical trial end point. The objective of this study was to compare the rate of silent AMI as measured by the Selvester QRS score in patients with a non-ST-segment elevation acute coronary syndrome treated with enoxaparin versus intravenous unfractionated heparin who were participating in a continuous ECG monitoring substudy of the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-wave Coronary Events study (ESSENCE) and INTegrelin and Enoxaparin Randomized Assessment of acute Coronary syndrome Treatment trial (INTERACT). Enoxaparin was associated with a 56% relative risk decrease in silent AMI at 96 hours compared with unfractionated heparin (2.7% vs 6.1% p = 0.03). Similarly, enoxaparin decreased Holter-detected myocardial ischemia compared with unfractionated heparin (18.7% vs 35.9%, p = 0.03). In conclusion, enoxaparin significantly decreased the composite of silent AMI or clinical AMI and death at 1 year (9.3% vs 21%, p = 0.0001).
Full Text
Duke Authors
Cited Authors
- Jolly, S; Tan, M; Mendelsohn, A; Fitchett, D; Armstrong, PW; Langer, A; Goodman, SG
Published Date
- January 15, 2007
Published In
Volume / Issue
- 99 / 2
Start / End Page
- 186 - 188
PubMed ID
- 17223416
International Standard Serial Number (ISSN)
- 0002-9149
Digital Object Identifier (DOI)
- 10.1016/j.amjcard.2006.07.078
Language
- eng
Conference Location
- United States