PMID- 18196350
OWN - NLM
STAT- MEDLINE
DCOM- 20080313
LR  - 20220318
IS  - 1525-1497 (Electronic)
IS  - 0884-8734 (Print)
IS  - 0884-8734 (Linking)
VI  - 23
IP  - 3
DP  - 2008 Mar
TI  - Prediction of one-year survival in high-risk patients with acute coronary 
      syndromes: results from the SYNERGY trial.
PG  - 310-6
LID - 10.1007/s11606-007-0498-4 [doi]
AB  - BACKGROUND: Despite advances in pharmacologic therapy and invasive management 
      strategies for patients with non-ST-segment elevation acute coronary syndromes 
      (NSTE ACS), these patients still suffer substantial morbidity and mortality. 
      OBJECTIVE: The objective of this study was to analyze independent predictors of 
      1-year mortality in patients with high-risk NSTE ACS. DESIGN AND PARTICIPANTS: A 
      total of 9,978 patients were assigned to receive enoxaparin or unfractionated 
      heparin (UFH) in this prospective, randomized, open-label, international trial. 
      MEASUREMENTS: Vital status at 1 year was collected. Univariable and multivariable 
      predictors of 1-year mortality were identified. Three different multivariable 
      regression models were constructed to identify: (1) predictors of 30-day 
      mortality; (2) predictors of 1-year mortality; (3) predictors of 1-year mortality 
      in 30-day survivors. The last model is the focus of this paper. RESULTS: Overall, 
      9,922 (99.4%) of patients had 1-year follow-up. Of the 56 patients (37 
      UFH-assigned and 19 enoxaparin-assigned) without 1-year data, 11 patients were 
      excluded because of withdrawal of consent, and 45 could not be located. One-year 
      mortality was 7.5% (7.7% enoxaparin-assigned patients; 7.3% UFH-assigned 
      patients; P = 0.4). In patients surviving 30 days after enrollment, independent 
      predictors of 1-year mortality included factors known at baseline such as 
      increased age, male sex, decreased weight, having ever smoked, decreased 
      creatinine clearance, ST-segment depression, history of diabetes, history of 
      angina, congestive heart failure, coronary artery bypass grafting, increased 
      heart rate, rales, increased hematocrit, lowered hemoglobin, and higher platelet 
      count. Factors predictive of mortality during the hospitalization and 30-day 
      follow-up period were decreased weight at 30 days from baseline, atrial 
      fibrillation, decreased nadir platelet, no use of beta-blockers and statins up to 
      30 days, and not receiving an intervention (c-index = 0.82). CONCLUSIONS: Easily 
      determined baseline clinical characteristics can be used to predict 1-year 
      mortality with reasonable discriminative power. These models corroborate prior 
      work in a contemporary aggressively managed population. A model to predict 1-year 
      mortality in patients surviving at least 30 days may be quite helpful to 
      healthcare providers in setting expectations and goals with patients after ACS.
FAU - Mahaffey, Kenneth W
AU  - Mahaffey KW
AD  - Duke Clinical Research Institute, Durham, NC 27715, USA. mahaf002@mc.duke.edu
FAU - Yang, Qinghong
AU  - Yang Q
FAU - Pieper, Karen S
AU  - Pieper KS
FAU - Antman, Elliott M
AU  - Antman EM
FAU - White, Harvey D
AU  - White HD
FAU - Goodman, Shaun G
AU  - Goodman SG
FAU - Cohen, Marc
AU  - Cohen M
FAU - Kleiman, Neal S
AU  - Kleiman NS
FAU - Langer, Anatoly
AU  - Langer A
FAU - Aylward, Philip E
AU  - Aylward PE
FAU - Col, Jacques J
AU  - Col JJ
FAU - Reist, Craig
AU  - Reist C
FAU - Ferguson, James J
AU  - Ferguson JJ
FAU - Califf, Robert M
AU  - Califf RM
CN  - SYNERGY Trial Investigators
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20080115
PL  - United States
TA  - J Gen Intern Med
JT  - Journal of general internal medicine
JID - 8605834
RN  - 0 (Enoxaparin)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Acute Coronary Syndrome/diagnosis/*drug therapy/*mortality
MH  - Aged
MH  - Aged, 80 and over
MH  - *Cause of Death
MH  - Coronary Angiography/methods
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Electrocardiography
MH  - Enoxaparin/*administration & dosage
MH  - Female
MH  - Follow-Up Studies
MH  - Heparin, Low-Molecular-Weight/*administration & dosage
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Predictive Value of Tests
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Single-Blind Method
MH  - Survival Analysis
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC2359476
EDAT- 2008/01/16 09:00
MHDA- 2008/03/14 09:00
PMCR- 2009/03/01
CRDT- 2008/01/16 09:00
PHST- 2007/03/22 00:00 [received]
PHST- 2007/12/17 00:00 [accepted]
PHST- 2007/09/07 00:00 [revised]
PHST- 2008/01/16 09:00 [pubmed]
PHST- 2008/03/14 09:00 [medline]
PHST- 2008/01/16 09:00 [entrez]
PHST- 2009/03/01 00:00 [pmc-release]
AID - 498 [pii]
AID - 10.1007/s11606-007-0498-4 [doi]
PST - ppublish
SO  - J Gen Intern Med. 2008 Mar;23(3):310-6. doi: 10.1007/s11606-007-0498-4. Epub 2008 
      Jan 15.