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European Heart Journal Advance Access originally published online on June 28, 2007
European Heart Journal 2007 28(17):2070-2076; doi:10.1093/eurheartj/ehm210
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

A strategy of using enoxaparin as adjunctive antithrombin therapy reduces death and recurrent myocardial infarction in patients who achieve early ST-segment resolution after fibrinolytic therapy: the ExTRACT-TIMI 25 ECG study

Benjamin M. Scirica1,*, David A. Morrow1, Zygmunt Sadowski2, Mikhail Ruda3, José Carlos Nicolau4, Robert P. Giugliano1, Stephen D. Wiviott1, Marc S. Sabatine1, Amy Shui1, Elliott M. Antman1 and Eugene Braunwald1

1 TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 350 Longwood Avenue, First Floor, Boston, MA 02115, USA
2 National Institute of Cardiology, Warsaw, Poland
3 Department of Emergency Cardiology, Cardiology Research Center, Moscow, Russia
4 Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil

Received 19 December 2006; revised 30 April 2007; accepted 3 May 2007; online publish-ahead-of-print 28 June 2007.

* Corresponding author. Tel: +1 617 278 0145; fax: +1 888 249 5261. E-mail address: bscirica{at}partners.org

Aims: To determine the relationship between a strategy of enoxaparin (ENOX), early ST-segment resolution (STRes), and clinical outcomes on patients with ST-segment elevation myocardial infarction (STEMI) after fibrinolysis.

Methods and results: Baseline and 180 min ECGs were analysed in 3208 of the 20 479 patients in the ExTRACT-TIMI 25 trial, which randomifzed patients with STEMI to ENOX vs. unfractionated heparin (UFH) as adjunctive therapy. STRes was defined as complete (70%), partial (30–70%), or none (<30%). There was no evidence for a difference in STRes between the groups assigned to the ENOX or UFH (median 69.4 vs. 67.2%; P = 0.13). Among patients with complete STRes (n = 1100), ENOX significantly reduced death or non-fatal recurrent MI at 30 days when compared with UFH (4.4 vs. 9.9%; ORadj 0.39; P < 0.001), whereas there was no difference in patients with only partial or no STRes [14.2 vs. 12.5%; ORadj 1.0; P = 0.98 (n = 368) and 16.2 vs. 15.9%; ORadj 1.0; P = 0.97 (n = 830), P for interaction = 0.008].

Conclusion: When compared with UFH, a strategy of ENOX significantly reduces death or non-fatal recurrent MI in patients who achieved complete STRes, but not in patients with less STRes. These data suggest that a strategy of ENOX improves outcomes by preventing re-occlusion in patients achieving initial successful reperfusion after fibrinolytic therapy rather than by facilitating initial reperfusion.

Key Words: STEMI • Enoxaparin • ECG • ST-segment resolution


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