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Low molecular weight heparin decreases rebound ischemia in unstable angina or non-Q-wave myocardial infarction: the Canadian ESSENCE ST segment monitoring substudy
Journal article   Open access   Peer reviewed

Low molecular weight heparin decreases rebound ischemia in unstable angina or non-Q-wave myocardial infarction: the Canadian ESSENCE ST segment monitoring substudy

Shaun G Goodman, Aiala Barr, Anatoli Sobtchouk, Marc Cohen, Gregg J Fromell, Luc Laperrière, Carol Hill, Anatoly Langer, for the Canadian Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) ST Segment Monitoring Substudy Group and Chelsey H Hill
Journal of the American College of Cardiology, v 36(5), pp 1507-1513
01 Nov 2000
DOI: https://doi.org/10.1016/S0735-1097(00)00915-3
PMID: 11079650
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1016/s0735-1097(00)00915-3View
Published, Version of Record (VoR)Open Access (Publisher-Specific),  Open

Abstract

LMWH ESSENCE OR CI UFH ECG MI
OBJECTIVES The goal of this study was to determine whether enoxaparin was more effective than heparin in reducing recurrent ischemic episodes. BACKGROUND Continuous ST segment monitoring is a simple tool for assessment of ischemia and identifies patients with a worse prognosis. Little is known about the impact of low molecular weight heparin on ST segment shift. METHODS Patients were randomized to receive enoxaparin or heparin (mean 3.4 days). Three-lead ST segment monitoring was performed for the first 48 h (n = 220) and an additional 48 h (n = 174) after intravenous study drug discontinuation (mean 1.9 days later). RESULTS During initial monitoring, ischemia rates were similar among the heparin and enoxaparin groups (27.2% vs. 22.6%, p = 0.44); however, the time to first ischemic episode was earlier among heparin-treated patients (11 ± 11 vs. 25 ± 18 min, p = 0.001). After drug discontinuation, ischemic episodes occurred more frequently (44.6% vs. 25.6%, p = 0.009), and the total ischemic duration was greater among heparin patients (18 ± 39 vs. 5 ± 12 min/24 h, p = 0.005). Recurrent ischemia occurred more frequently after discontinuation in the heparin (46% vs. 31%, p = 0.043), but not the enoxaparin, group (18.4% vs. 25%, p = 0.33). Regardless of treatment, patients with ischemia were more likely to die or experience (re)infarction at one year (18.4% vs. 8.3%, p = 0.023). CONCLUSIONS ST segment shift occurs frequently in unstable angina/non-Q-wave myocardial infarction despite antithrombotic therapy and is associated with worse one-year prognosis. Enoxaparin is a more effective antithrombotic treatment than unfractionated heparin and leads to greater prevention of rebound ischemia.

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43 citations in Web of Science
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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Cardiac & Cardiovascular Systems
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