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

Chadwick D. Miller, Anindita Banerjee, Kenneth W. Mahaffey, Michael C. Kontos, Gregory Fermann, Charles V. Pollack, Elliott Antman, Philip Aylward, Shaun G. Goodman, Renato Santos, James J. Ferguson, Robert M. Califf, James W. Hoekstra

Research output: Contribution to journalArticle

9 Citations (Scopus)

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 ≥ 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 χ2 tests. Of the 8309 patients with complete data, 5503 (66%) had MI, 1686 (20%) had EMI, and 1120 (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.

LanguageEnglish
Pages1079-1084
Number of pages6
JournalEuropean Heart Journal
Volume28
Issue number9
DOIs
Publication statusPublished - 1 May 2007

Keywords

  • Evolving myocardial infarction
  • Initial treatment
  • Outcomes
  • Troponin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Miller, C. D., Banerjee, A., Mahaffey, K. W., Kontos, M. C., Fermann, G., Pollack, C. V., ... Hoekstra, J. W. (2007). Treatment and outcomes of patients with evolving myocardial infarction: Experiences from the SYNERGY trial. European Heart Journal, 28(9), 1079-1084. https://doi.org/10.1093/eurheartj/ehm016
Miller, Chadwick D. ; Banerjee, Anindita ; Mahaffey, Kenneth W. ; Kontos, Michael C. ; Fermann, Gregory ; Pollack, Charles V. ; Antman, Elliott ; Aylward, Philip ; Goodman, Shaun G. ; Santos, Renato ; Ferguson, James J. ; Califf, Robert M. ; Hoekstra, James W. / Treatment and outcomes of patients with evolving myocardial infarction : Experiences from the SYNERGY trial. In: European Heart Journal. 2007 ; Vol. 28, No. 9. pp. 1079-1084.
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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 ≥ 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 χ2 tests. Of the 8309 patients with complete data, 5503 (66{\%}) had MI, 1686 (20{\%}) had EMI, and 1120 (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.",
keywords = "Evolving myocardial infarction, Initial treatment, Outcomes, Troponin",
author = "Miller, {Chadwick D.} and Anindita Banerjee and Mahaffey, {Kenneth W.} and Kontos, {Michael C.} and Gregory Fermann and Pollack, {Charles V.} and Elliott Antman and Philip Aylward and Goodman, {Shaun G.} and Renato Santos and Ferguson, {James J.} and Califf, {Robert M.} and Hoekstra, {James W.}",
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Miller, CD, Banerjee, A, Mahaffey, KW, Kontos, MC, Fermann, G, Pollack, CV, Antman, E, Aylward, P, Goodman, SG, Santos, R, Ferguson, JJ, Califf, RM & Hoekstra, JW 2007, 'Treatment and outcomes of patients with evolving myocardial infarction: Experiences from the SYNERGY trial', European Heart Journal, vol. 28, no. 9, pp. 1079-1084. https://doi.org/10.1093/eurheartj/ehm016

Treatment and outcomes of patients with evolving myocardial infarction : Experiences from the SYNERGY trial. / Miller, Chadwick D.; Banerjee, Anindita; Mahaffey, Kenneth W.; Kontos, Michael C.; Fermann, Gregory; Pollack, Charles V.; Antman, Elliott; Aylward, Philip; Goodman, Shaun G.; Santos, Renato; Ferguson, James J.; Califf, Robert M.; Hoekstra, James W.

In: European Heart Journal, Vol. 28, No. 9, 01.05.2007, p. 1079-1084.

Research output: Contribution to journalArticle

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AU - Miller, Chadwick D.

AU - Banerjee, Anindita

AU - Mahaffey, Kenneth W.

AU - Kontos, Michael C.

AU - Fermann, Gregory

AU - Pollack, Charles V.

AU - Antman, Elliott

AU - Aylward, Philip

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AU - Hoekstra, James W.

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N2 - 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 ≥ 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 χ2 tests. Of the 8309 patients with complete data, 5503 (66%) had MI, 1686 (20%) had EMI, and 1120 (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.

AB - 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 ≥ 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 χ2 tests. Of the 8309 patients with complete data, 5503 (66%) had MI, 1686 (20%) had EMI, and 1120 (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.

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