Prediction of One-Year Survival in High-Risk Patients with Acute Coronary Syndromes: Results from the SYNERGY Trial
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- 作者：Kenneth W. Mahaffey MD (1)
Qinghong Yang MS (1)
Karen S. Pieper MS (1)
Elliott M. Antman MD (2)
Harvey D. White DSc (3)
Shaun G. Goodman MD (4)
Marc Cohen MD (5)
Neal S. Kleiman MD (6)
Anatoly Langer MD (4)
Philip E. Aylward MD (7)
Jacques J. Col MD (8)
Craig Reist PhD (1)
James J. Ferguson MD (9)
Robert M. Califf MD (1) - 关键词：non ; ST ; segment elevation acute coronary syndrome ; predictors ; mortality ; outcomes ; low ; molecular ; weight heparin ; unfractionated heparin
- 刊名：Journal of General Internal Medicine
- 出版年：2008
- 出版时间：March 2008
- 年：2008
- 卷：23
- 期：3
- 页码：310-316
- 全文大小：169KB
- 参考文献：1. de Araujo Goncalves P, Ferreira J, Aguiar C, Seabra-Gomes R. TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS. Eur Heart J. 2005;26:865-2. dx.doi.org/10.1093/eurheartj/ehi187">CrossRef
2. Ferguson JJ, Califf RM, Antman EM, SYNERGY Investigators, et al. Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. JAMA. 2004;292:45-4. dx.doi.org/10.1001/jama.292.1.45">CrossRef
3. Mahaffey KW, Cohen M, Garg J, 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;294:2594-600. dx.doi.org/10.1001/jama.294.20.2594">CrossRef
4. SYNERGY Executive Committee. The SYNERGY Trial: study design and rationale. Am Heart J.. 2002;143:952-0. dx.doi.org/10.1067/mhj.2002.122120">CrossRef
5. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction-2002: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). Circulation. 2002;106:1893-900. dx.doi.org/10.1161/01.CIR.0000037106.76139.53">CrossRef
6. Bertrand ME, Simoons ML, Fox KA, et al. Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2002;23:1809-0. dx.doi.org/10.1053/euhj.2002.3385">CrossRef
7. Harrell FE Jr. Regression modeling strategies with applications to linear models, logistic regression, and survival analysis. New York: Springer; 2001:253-1.
8. Antman EM, Cohen M, Bernink PJLM, et al. The TIMI risk score for unstable angina/non-ST elevation MI. JAMA. 2000;284:835-2. dx.doi.org/10.1001/jama.284.7.835">CrossRef
9. Boersma E, Pieper KS, Steyerberg EW, et al. for the PURSUIT investigators. Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation. Results from an international trial of 9461 patients. Circulation. 2000;101:2557-7.
10. Granger CB, Goldberg RJ, Dabbous OH, Global Registry of Acute Coronary Events Investigators, et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med. 2003;163:2345-3. dx.doi.org/10.1001/archinte.163.19.2345">CrossRef - 作者单位：Kenneth W. Mahaffey MD (1)
Qinghong Yang MS (1)
Karen S. Pieper MS (1)
Elliott M. Antman MD (2)
Harvey D. White DSc (3)
Shaun G. Goodman MD (4)
Marc Cohen MD (5)
Neal S. Kleiman MD (6)
Anatoly Langer MD (4)
Philip E. Aylward MD (7)
Jacques J. Col MD (8)
Craig Reist PhD (1)
James J. Ferguson MD (9)
Robert M. Califf MD (1)
1. Duke Clinical Research Institute, Durham, NC, USA
2. Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
3. Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
4. Canadian Heart Research Centre, Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
5. Newark Beth Israel Medical Center, Newark, NJ, USA
6. The Methodist DeBakey Heart Center, Houston, TX, USA
7. Flinders Medical Centre, Adelaide, South Australia
8. Clinique Universitaire St. Luc, Brussels, Belgium
9. Texas Heart Institute, Houston, TX, USA
文摘
BACKGROUND Despite advances in pharmacologic therapy and invasive management strategies for patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS), these patients still suffer substantial morbidity and mortality. OBJECTIVE The objective of this study was to analyze independent predictors of 1-year mortality in patients with high-risk NSTE ACS. DESIGN AND PARTICIPANTS A total of 9,978 patients were assigned to receive enoxaparin or unfractionated heparin (UFH) in this prospective, randomized, open-label, international trial. MEASUREMENTS Vital status at 1?year was collected. Univariable and multivariable predictors of 1-year mortality were identified. Three different multivariable regression models were constructed to identify: (1) predictors of 30-day mortality; (2) predictors of 1-year mortality; (3) predictors of 1-year mortality in 30-day survivors. The last model is the focus of this paper. RESULTS Overall, 9,922 (99.4%) of patients had 1-year follow-up. Of the 56 patients (37 UFH-assigned and 19 enoxaparin-assigned) without 1-year data, 11 patients were excluded because of withdrawal of consent, and 45 could not be located. One-year mortality was 7.5% (7.7% enoxaparin-assigned patients; 7.3% UFH-assigned patients; P-/em>=-.4). In patients surviving 30?days after enrollment, independent predictors of 1-year mortality included factors known at baseline such as increased age, male sex, decreased weight, having ever smoked, decreased creatinine clearance, ST-segment depression, history of diabetes, history of angina, congestive heart failure, coronary artery bypass grafting, increased heart rate, rales, increased hematocrit, lowered hemoglobin, and higher platelet count. Factors predictive of mortality during the hospitalization and 30-day follow-up period were decreased weight at 30?days from baseline, atrial fibrillation, decreased nadir platelet, no use of beta-blockers and statins up to 30?days, and not receiving an intervention (c-index--.82). CONCLUSIONS Easily determined baseline clinical characteristics can be used to predict 1-year mortality with reasonable discriminative power. These models corroborate prior work in a contemporary aggressively managed population. A model to predict 1-year mortality in patients surviving at least 30?days may be quite helpful to healthcare providers in setting expectations and goals with patients after ACS.