PMID- 19012977
OWN - NLM
STAT- MEDLINE
DCOM- 20100607
LR  - 20191210
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 139
IP  - 2
DP  - 2010 Mar 4
TI  - Obesity in patients with non-ST-segment elevation acute coronary syndromes: 
      results from the SYNERGY trial.
PG  - 123-33
LID - 10.1016/j.ijcard.2008.10.008 [doi]
AB  - BACKGROUND: Obese patients are at increased risk of acute coronary syndromes 
      (ACS). We evaluated the prevalence of obesity in a large ACS population, as well 
      as the relationship between body mass index (BMI) and the use of cardiac 
      medications and procedures, clinical outcomes, and treatment effects between 
      enoxaparin and unfractionated heparin (UFH). METHODS: Using the database of the 
      SYNERGY trial, we identified 9978 patients in 12 countries who were randomly 
      assigned to receive enoxaparin or UFH. Patient weight at baseline and 30-day 
      follow-up was recorded. BMI information was available on 9837 patients. BMI was 
      analyzed in clinically meaningful categories (<20, 20-25, 30-35, > or =35 
      kg/m(2)) and as a continuous variable. RESULTS: Thirty-two percent of patients 
      were obese (BMI> or =30), with a greater proportion of patients with obesity from 
      North America (36%) compared with other regions. Enoxaparin was dosed as 1 mg/kg 
      regardless of body weight without maximum. The first dose of enoxaparin was 
      underdosed in 15% of patients assigned enoxaparin, and obese patients were more 
      likely to be underdosed than non-obese patients. Obese patients were younger, 
      less often white, had more diabetes, hypertension, hyperlipidemia, family history 
      of coronary artery disease, and congestive heart failure but fewer strokes, less 
      peripheral vascular disease, and less often smoked. After adjustment, increased 
      BMI was not an independent predictor of bleeding outcomes or 30-day 
      death/myocardial infarction (MI), but increased BMI was predictive of lower 
      1-year mortality in the subgroup of patients with BMI at baseline below 
      approximately 30 kg/m(2). No statistical interaction term was observed between 
      obesity and randomized therapy for the outcomes of death/MI at 30 days and 6 
      months; death at 30 days, 6 months, and 1 year; and GUSTO or TIMI bleeding. 
      CONCLUSIONS: Nearly one third of patients in SYNERGY were obese. Despite multiple 
      comorbidities, obese patients had better unadjusted short- and long-term 
      outcomes. After adjustment, higher BMI was not an independent predictor of 
      in-hospital bleeding events or 30-day death/MI, but increased BMI was an 
      independent predictor of 1-year mortality in patients with lower BMI but not in 
      heavier patients. No interaction between the randomized treatment and obesity for 
      efficacy and safety outcomes was observed across the range of BMI in this 
      dataset. Standard dosing of enoxaparin should be used in patients without extreme 
      obesity due to limited outcome data in these patients.
CI  - Copyright 2008 Elsevier Ireland Ltd. All rights reserved.
FAU - Mahaffey, Kenneth W
AU  - Mahaffey KW
AD  - Duke Clinical Research Institute, Durham, NC 27715, USA. mahaf002@mc.duke.edu
FAU - Tonev, Simon T
AU  - Tonev ST
FAU - Spinler, Sarah A
AU  - Spinler SA
FAU - Levine, Glenn N
AU  - Levine GN
FAU - Gallo, Richard
AU  - Gallo R
FAU - Ducas, John
AU  - Ducas J
FAU - Goodman, Shaun G
AU  - Goodman SG
FAU - Antman, Elliott M
AU  - Antman EM
FAU - Becker, Richard C
AU  - Becker RC
FAU - Langer, Anatoly
AU  - Langer A
FAU - White, Harvey D
AU  - White HD
FAU - Aylward, Philip E
AU  - Aylward PE
FAU - Col, Jacques J
AU  - Col JJ
FAU - Ferguson, James J
AU  - Ferguson JJ
FAU - Califf, Robert M
AU  - Califf RM
CN  - SYNERGY Trial Investigators
LA  - eng
PT  - Journal Article
DEP - 20081114
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
SB  - IM
MH  - Acute Coronary Syndrome/diagnosis/*drug therapy/*mortality
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Body Mass Index
MH  - Comorbidity
MH  - Databases, Factual
MH  - Electrocardiography
MH  - Enoxaparin/*administration & dosage/adverse effects
MH  - Female
MH  - Hemorrhage/mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multicenter Studies as Topic/statistics & numerical data
MH  - Myocardial Revascularization/statistics & numerical data
MH  - Obesity/*mortality
MH  - *Outcome Assessment, Health Care
MH  - Predictive Value of Tests
MH  - Randomized Controlled Trials as Topic/statistics & numerical data
MH  - Risk Factors
EDAT- 2008/11/18 09:00
MHDA- 2010/06/09 06:00
CRDT- 2008/11/18 09:00
PHST- 2007/10/24 00:00 [received]
PHST- 2008/09/22 00:00 [revised]
PHST- 2008/10/12 00:00 [accepted]
PHST- 2008/11/18 09:00 [pubmed]
PHST- 2010/06/09 06:00 [medline]
PHST- 2008/11/18 09:00 [entrez]
AID - S0167-5273(08)01066-8 [pii]
AID - 10.1016/j.ijcard.2008.10.008 [doi]
PST - ppublish
SO  - Int J Cardiol. 2010 Mar 4;139(2):123-33. doi: 10.1016/j.ijcard.2008.10.008. Epub 
      2008 Nov 14.