| TIMI risk index and the benefit of enoxaparin in patients with ST-elevation myocardial infarction. | |
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MedLine Citation:
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PMID: 17976428 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: The purpose of the study was to evaluate the cause of death, risk of nonfatal complications, and relative outcomes with an enoxaparin versus unfractionated heparin strategy in ST-elevation myocardial infarction stratified using the Thrombolysis in Myocardial Infarction (TIMI) Risk Index (TRI). METHODS: We evaluated 30-day outcomes in 19,941 patients with ST-elevation myocardial infarction treated with fibrinolysis and unfractionated heparin or enoxaparin. Patients were categorized on the basis of prespecified ranges of the TRI [heart rate x (age/10)2/systolic blood pressure]. RESULTS: There was a strongly graded increase in 30-day mortality with increasing TRI (1.2%-20.7%, P<.0001). The proportion of deaths due to mechanical causes (congestive heart failure, shock, and myocardial rupture) increased progressively with the TRI. There also was a significant positively graded association between the TRI and nonfatal heart failure or shock (0.4%-4.4%, P<.0001). In contrast, death resulting from recurrent ischemic events predominated in the lowest TRI group. The relative reduction in death/myocardial infarction with the enoxaparin strategy appeared inversely graded with the TRI. There was a 38% reduction in the lowest risk group (relative risk 0.62, 95% confidence interval 0.45-0.86) and a decrease in the relative benefit of enoxaparin with increasing risk index. CONCLUSIONS: The TRI was a strong predictor of all-cause mortality in a broad population, with a positive association with the risk of death due to mechanical complications and an inverse association with deaths due to recurrent ischemia. The enoxaparin strategy was superior to unfractionated heparin in a majority of patients with ST-elevation myocardial infarction, except for the group at the highest risk for severe mechanical complications, in whom the 2 anticoagulant strategies showed similar results. |
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Authors:
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Christian T Ruff; Stephen D Wiviott; David A Morrow; Satishkumar Mohanavelu; Sabina A Murphy; Elliott M Antman; Eugene Braunwald; |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The American journal of medicine Volume: 120 ISSN: 1555-7162 ISO Abbreviation: Am. J. Med. Publication Date: 2007 Nov |
Date Detail:
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Created Date: 2007-11-02 Completed Date: 2007-11-29 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0267200 Medline TA: Am J Med Country: United States |
Other Details:
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Languages: eng Pagination: 993-8 Citation Subset: AIM; IM |
Affiliation:
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TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA. cruff@partners.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Arrhythmias, Cardiac Cause of Death Enoxaparin / administration & dosage, therapeutic use* Fibrinolytic Agents / therapeutic use* Hemorrhage Heparin / therapeutic use Humans Middle Aged Myocardial Infarction / complications, drug therapy* Risk Factors |
| Chemical | |
Reg. No./Substance:
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0/Enoxaparin; 0/Fibrinolytic Agents; 9005-49-6/Heparin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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