PMID- 24012033
OWN - NLM
STAT- MEDLINE
DCOM- 20131210
LR  - 20220316
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 112
IP  - 9
DP  - 2013 Nov 1
TI  - A direct comparison of intravenous enoxaparin with unfractionated heparin in 
      primary percutaneous coronary intervention (from the ATOLL trial).
PG  - 1367-72
LID - S0002-9149(13)01510-5 [pii]
LID - 10.1016/j.amjcard.2013.07.003 [doi]
AB  - Intravenous enoxaparin did not reduce significantly the primary end point (p = 
      0.06) compared with unfractionated heparin (UFH) in the randomized Acute 
      Myocardial Infarction Treated with primary angioplasty and intravenous enoxaparin 
      Or unfractionated heparin to Lower ischemic and bleeding events at short- and 
      Long-term follow-up (ATOLL) trial. We present the results of the prespecified 
      per-protocol analysis excluding patients who did not receive the treatment 
      allocated by randomization or received both enoxaparin and UFH. We evaluated 
      all-cause mortality, complication of myocardial infarction, procedural failure, 
      or major bleeding (primary end point) and all-cause mortality, recurrent acute 
      coronary syndrome, or urgent revascularization (main secondary end point). 
      Baseline and procedural characteristics were well balanced between the 2 
      treatment groups. Of 910 randomized patients, 795 patients (87.4%) were treated 
      according to the protocol with consistent anticoagulation using intravenous 
      enoxaparin (n = 400) or UFH (n = 395). Enoxaparin reduced significantly the rates 
      of the primary end point (relative risk [RR] 0.76, 95% confidence interval [CI] 
      0.62 to 0.94, p = 0.012) and the main secondary end point (RR 0.37, 95% CI 0.22 
      to 0.63, p <0.0001). There was less major bleeding with enoxaparin (RR 0.46, 95% 
      CI 0.21 to 1.01, p = 0.050) contributing to the significant improvement of the 
      net clinical benefit (RR 0.46, 95% CI 0.3 to 0.74, p = 0.0002). All-cause 
      mortality was also reduced with enoxaparin (RR 0.36, 95% CI 0.18 to 0.74, p = 
      0.003). In conclusion, in the per-protocol analysis of the ATOLL trial, pertinent 
      to >87% of the study population, enoxaparin was superior to UFH in reducing 
      ischemic end points and mortality.
CI  - Copyright (c) 2013 Elsevier Inc. All rights reserved.
FAU - Collet, Jean-Philippe
AU  - Collet JP
AD  - Institut de Cardiologie, INSERM UMRS937, Hopital Pitie-Salpetriere (AP-HP), 
      Universite Paris 6, Paris, France; ACTION study group, Paris, France.
FAU - Huber, Kurt
AU  - Huber K
FAU - Cohen, Marc
AU  - Cohen M
FAU - Zeymer, Uwe
AU  - Zeymer U
FAU - Goldstein, Patrick
AU  - Goldstein P
FAU - Pollack, Charles Jr
AU  - Pollack C Jr
FAU - Silvain, Johanne
AU  - Silvain J
FAU - Henry, Patrick
AU  - Henry P
FAU - Varenne, Olivier
AU  - Varenne O
FAU - Carrie, Didier
AU  - Carrie D
FAU - Coste, Pierre
AU  - Coste P
FAU - Angioi, Michael
AU  - Angioi M
FAU - Le Breton, Herve
AU  - Le Breton H
FAU - Cayla, Guillaume
AU  - Cayla G
FAU - Elhadad, Simon
AU  - Elhadad S
FAU - Teiger, Emmanuel
AU  - Teiger E
FAU - Filippi, Emmanuelle
AU  - Filippi E
FAU - Aout, Mounir
AU  - Aout M
FAU - Vicaut, Eric
AU  - Vicaut E
FAU - Montalescot, Gilles
AU  - Montalescot G
CN  - ATOLL Investigators
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20130905
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/administration & dosage
MH  - Austria/epidemiology
MH  - Cause of Death/trends
MH  - Dose-Response Relationship, Drug
MH  - Drug Therapy, Combination
MH  - *Electrocardiography
MH  - Enoxaparin/*administration & dosage
MH  - Female
MH  - Follow-Up Studies
MH  - France/epidemiology
MH  - Germany/epidemiology
MH  - Heparin/*administration & dosage
MH  - Humans
MH  - Incidence
MH  - Injections, Intravenous
MH  - Injections, Subcutaneous
MH  - Intraoperative Period
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*drug therapy/mortality
MH  - *Percutaneous Coronary Intervention
MH  - Postoperative Complications/epidemiology
MH  - Prospective Studies
MH  - Survival Rate/trends
MH  - Treatment Outcome
MH  - United States/epidemiology
EDAT- 2013/09/10 06:00
MHDA- 2013/12/16 06:00
CRDT- 2013/09/10 06:00
PHST- 2013/05/22 00:00 [received]
PHST- 2013/07/12 00:00 [revised]
PHST- 2013/07/12 00:00 [accepted]
PHST- 2013/09/10 06:00 [entrez]
PHST- 2013/09/10 06:00 [pubmed]
PHST- 2013/12/16 06:00 [medline]
AID - S0002-9149(13)01510-5 [pii]
AID - 10.1016/j.amjcard.2013.07.003 [doi]
PST - ppublish
SO  - Am J Cardiol. 2013 Nov 1;112(9):1367-72. doi: 10.1016/j.amjcard.2013.07.003. Epub 
      2013 Sep 5.