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SYNERGY Trial Outcomes at 6 and 12 Months

Patients with non–ST-segment–elevation acute coronary syndromes remain at high risk for adverse events at 1 year, despite aggressive treatment.

In the SYNERGY trial, 9978 patients with non–ST-segment–elevation acute coronary syndromes were randomized to receive low-molecular-weight heparin (enoxaparin) or unfractionated heparin until cardiac procedures were performed or antithrombin therapy was no longer needed. Patients were also treated with evidence-based strategies. In an earlier report of findings at 30 days, enoxaparin was found to be at least as effective as heparin. The researchers now report findings at 6 and 12 months.

At 6 months, the enoxaparin and heparin groups had similar rates of death and nonfatal MI (17.6% and 17.8%) and rehospitalization (17.9% and 19.9%). Rates of all-cause mortality at 1 year also were similar in the two groups (7.6% and 7.3%).

Comment: Two conclusions can be drawn from this study. First, the main outcome measures were similar in enoxaparin patients and heparin patients at 30 days, 6 months, and 1 year. Second, and more important, patients with non–ST-segment–elevation acute coronary syndromes remain at high risk for recurrent cardiovascular events, revascularization procedures, and death despite use of glycoprotein IIb/IIIa inhibitors, enoxaparin or heparin, and aggressive revascularization strategies.

— John A. Marx, MD, FAAEM, FACEP

Published in Journal Watch Emergency Medicine February 28, 2006

Citation(s):

Mahaffey KW et al. High-risk patients with acute coronary syndromes treated with low-molecular-weight or unfractionated heparin: Outcomes at 6 months and 1 year in the SYNERGY trial. JAMA 2005 Nov 23/30; 294:2594-600.

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