PMID- 18519426
OWN - NLM
STAT- MEDLINE
DCOM- 20081224
LR  - 20220321
IS  - 1522-9645 (Electronic)
IS  - 0195-668X (Linking)
VI  - 29
IP  - 15
DP  - 2008 Aug
TI  - Outcomes in elderly patients with acute coronary syndromes randomized to 
      enoxaparin vs. unfractionated heparin: results from the SYNERGY trial.
PG  - 1827-33
LID - 10.1093/eurheartj/ehn236 [doi]
AB  - AIMS: Elderly patients are at high risk from non-ST-segment elevation acute 
      coronary syndromes (NSTE ACS) as well as from treatment-related complications. 
      Age-associated changes in physiology may alter the risk and benefit expected from 
      therapy. The SYNERGY database was used to study the influence of age on treatment 
      outcomes with enoxaparin vs. unfractionated heparin (UFH) in patients with 
      high-risk NSTE ACS. METHODS AND RESULTS: Age was analysed as a continuous and 
      categorical variable (<65, 65-74, and >or=75 years, and <75 and >or=75 years) for 
      descriptive purposes. Logistic regression was used to adjust the outcomes of 
      30-day death, death or myocardial infarction (MI), and major bleeding for 
      baseline characteristics. Odds ratios compared outcomes by age and by treatment 
      within age groups. Model interaction terms were used to test for statistically 
      different outcomes by treatment and age. Overall, 9977 randomized patients had 
      age information, of whom 25.5% (2540) were >or=75 years of age. Elderly patients 
      (>or=75 years) had more cardiovascular risk factors, prior cardiac disease, and 
      higher acuity at presentation. After adjustment, advanced age (per 10 years) was 
      associated with 30-day death or MI [risk odds ratios (ROR): 1.14, P = 0.002], 
      30-day death (ROR: 1.54, P < 0.0001), and 1-year death (ROR: 1.47, P < 0.0001), 
      as well with TIMI major bleeding (ROR: 1.21, P = 0.001), GUSTO severe bleeding 
      (ROR: 1.20, P = 0.047), and transfusion (ROR: 1.04, P = 0.324). Although there 
      was a higher rate of GUSTO severe bleeding noted with enoxaparin in elderly 
      patients, the overall relationships between treatment (UFH or enoxaparin) and 
      outcomes did not vary significantly as a function of the patient's age. 
      CONCLUSION: Although higher rates of adverse events are seen in the oldest 
      subgroup (age >or=75 years) treated with enoxaparin, statistical comparisons 
      confirm similar efficacy and safety of enoxaparin and UFH across age subgroups as 
      was demonstrated overall in SYNERGY.
FAU - Lopes, Renato D
AU  - Lopes RD
AD  - Duke Clinical Research Institute, Box 3850, 2400 Pratt Street, Room 311, Terrace 
      Level, Durham, NC 27705, USA. renato.lopes@duke.edu
FAU - Alexander, Karen P
AU  - Alexander KP
FAU - Marcucci, Gretchen
AU  - Marcucci G
FAU - White, Harvey D
AU  - White HD
FAU - Spinler, Sarah
AU  - Spinler S
FAU - Col, Jacques
AU  - Col J
FAU - Aylward, Philip E
AU  - Aylward PE
FAU - Califf, Robert M
AU  - Califf RM
FAU - Mahaffey, Kenneth W
AU  - Mahaffey KW
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20080602
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Acute Coronary Syndrome/*drug therapy
MH  - Age Factors
MH  - Aged
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Coronary Angiography/methods
MH  - Cross-Over Studies
MH  - Electrocardiography
MH  - Enoxaparin/*administration & dosage/adverse effects
MH  - Female
MH  - Hemorrhage/chemically induced/drug therapy
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Practice Guidelines as Topic
MH  - Risk Factors
MH  - Secondary Prevention
MH  - Treatment Outcome
EDAT- 2008/06/04 09:00
MHDA- 2008/12/25 09:00
CRDT- 2008/06/04 09:00
PHST- 2008/06/04 09:00 [pubmed]
PHST- 2008/12/25 09:00 [medline]
PHST- 2008/06/04 09:00 [entrez]
AID - ehn236 [pii]
AID - 10.1093/eurheartj/ehn236 [doi]
PST - ppublish
SO  - Eur Heart J. 2008 Aug;29(15):1827-33. doi: 10.1093/eurheartj/ehn236. Epub 2008 
      Jun 2.