PMID- 16569535
OWN - NLM
STAT- MEDLINE
DCOM- 20060421
LR  - 20071115
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 151
IP  - 4
DP  - 2006 Apr
TI  - The greatest benefit of enoxaparin over unfractionated heparin in acute coronary 
      syndromes is achieved in patients presenting with ST-segment changes: the 
      Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) Electrocardiogram Core 
      Laboratory Substudy.
PG  - 791-7
AB  - BACKGROUND: We undertook a prospective electrocardiogram (ECG) substudy in the 
      ESSENCE trial and hypothesized that patient subgroups with ST-segment deviation 
      would experience greater benefit from enoxaparin, as compared with unfractionated 
      heparin (UFH). METHODS: Of the 3171 patients in the trial, 3087 had a qualifying 
      ECG available for analysis by the core laboratory. Patients were divided into 4 
      mutually exclusive groups based upon the qualifying ECG: (1) ST-segment 
      elevation, (2) ST-segment depression, (3) T-wave inversions, or (4) others. 
      RESULTS: The 30-day and 1-year primary outcomes (death, myocardial infarction, or 
      recurrent angina) were significantly lower among patients with ST elevation or ST 
      depression who received enoxaparin, as compared with UFH (20.8% vs 28.0%, P = 
      .0019 and 32% vs 40.4%, P = .0011, respectively). The greatest absolute benefit 
      of enoxaparin over UFH was seen in patients with ST depression (primary end point 
      at 30 days, 24.6% vs 32.4%, P = .018; at 1 year, 35.5% vs 44.5%, P = .012). 
      CONCLUSION: Specific recognition of patients with ST-segment depression appears 
      to identify those not only at high risk for adverse outcome, but also patients 
      most likely to derive the greatest benefit from enoxaparin, as compared with UFH 
      therapy.
FAU - Goodman, Shaun G
AU  - Goodman SG
AD  - Division of Cardiology, Canadian Heart Research Centre, St. Michael's Hospital, 
      University of Toronto, Toronto, Ontario, Canada. goodmans@smh.toronto.on.ca
FAU - Bozovich, Gerardo E
AU  - Bozovich GE
FAU - Tan, Mary
AU  - Tan M
FAU - Dos Santos, Alfonso
AU  - Dos Santos A
FAU - Gurfinkel, Enrique P
AU  - Gurfinkel EP
FAU - Cohen, Marc
AU  - Cohen M
FAU - Langer, Anatoly
AU  - Langer A
CN  - Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events 
      Study Group
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Angina, Unstable/*drug therapy/mortality
MH  - *Electrocardiography
MH  - Enoxaparin/*therapeutic use
MH  - Female
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Heparin/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multicenter Studies as Topic
MH  - Myocardial Infarction/*drug therapy/mortality
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Randomized Controlled Trials as Topic
MH  - Survival Analysis
MH  - Syndrome
MH  - Treatment Outcome
EDAT- 2006/03/30 09:00
MHDA- 2006/04/25 09:00
CRDT- 2006/03/30 09:00
PHST- 2005/06/10 00:00 [received]
PHST- 2005/08/11 00:00 [accepted]
PHST- 2006/03/30 09:00 [pubmed]
PHST- 2006/04/25 09:00 [medline]
PHST- 2006/03/30 09:00 [entrez]
AID - S0002-8703(05)00791-X [pii]
AID - 10.1016/j.ahj.2005.08.007 [doi]
PST - ppublish
SO  - Am Heart J. 2006 Apr;151(4):791-7. doi: 10.1016/j.ahj.2005.08.007.