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J Am Coll Cardiol, 2000; 36:693-698 © 2000 by the American College of Cardiology Foundation |
a Canadian Heart Research Center, Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
* Division of Cardiology, Allegheny University Hospitals, Hahnemann Division, Philadelphia, Pennsylvania, USA
Rhone-Poulenc Rorer Corp., Antony, France
d Rhone-Poulenc Rorer Corp., Collegeville, Pennsylvania, USA
Institute of Cardiology, Favaloro Foundation, Buenos Aires, Argentina
Hopital St. Sacrement, Quebec, Canada
|| McMaster University, Hamilton, Canada
¶ Duke University, Durham, North Carolina, USA
# Royal Infirmary, Edinburgh, United Kingdom
Manuscript received October 20, 1999; revised manuscript received February 22, 2000, accepted April 11, 2000.
Reprint requests and correspondence: Dr. Shaun G. Goodman, St. Michael’s Hospital, Division of Cardiology, 30 Bond Street, Room 9-005 Queen, Toronto, Ontario, Canada M5B 1W8
goodmans{at}smh.toronto.on.ca
OBJECTIVES
We sought to determine whether the observed benefits of enoxaparin were maintained beyond the early phase; a one-year follow-up survey was undertaken for patients enrolled in the Efficacy and Safety of Subcutaneous Enoxaparin in Non–Q wave Coronary Events (ESSENCE) study.
BACKGROUND
We have previously reported a significant benefit of low molecular weight as compared with unfractionated heparin (UFH) in the 14- and 30-day incidence of a composite end point of death, myocardial infarction (MI) or recurrent angina in patients with unstable angina or non–Q wave MI.
METHODS
The study recruited 3,171 patients with recent-onset rest angina and underlying ischemic heart disease. All patients received oral aspirin daily and were randomized to receive enoxaparin subcutaneously every 12 h or UFH (intravenous bolus followed by continuous infusion) in a double-blind, double-dummy fashion for a median of 2.6 days.
RESULTS
The incidence of the composite triple end point at one year was lower among patients receiving enoxaparin as compared with those receiving UFH (32.0% vs. 35.7%, p = 0.022), with a trend toward a lower incidence of the secondary composite end point of death or MI (11.5% vs. 13.5%, p = 0.082). At one year, the need for diagnostic catheterization and coronary revascularization was lower in the enoxaparin group (55.8% vs. 59.4%, p = 0.036 and 35.9% vs. 41.2%, p = 0.002, respectively).
CONCLUSIONS
In patients with unstable angina or non–Q wave MI, enoxaparin therapy significantly reduced the rates of recurrent ischemic events and invasive diagnostic and therapeutic procedures in the short term with sustained benefit at one year.
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