title: Treatment and outcomes of patients with evolving myocardial infarction: experiences from the SYNERGY trial.
abstract: OBJECTIVE
  Patients with myocardial infarction (MI) presenting immediately after symptom onset may be treated less aggressively due to their non-elevated troponin status. We compared the initial treatment and clinical outcomes of patients presenting with evolving MI (EMI) with those presenting with MI.
  
  
  RESULTS
  This study analysed data from the Superior Yield of the New strategy of Enoxaparin, Revascularisation, and Glycoprotein IIb/IIIa inhibitors (SYNERGY) trial, which enrolled patients meeting at least two of the following: age >or= 60 years, elevated cardiac biomarkers, or ST-segment changes. Patients were stratified by troponin results obtained within 12 h of presentation: EMI [initial troponin (-), second troponin (+)], MI [initial troponin (+)], and no MI at enrolment [first and second troponin (-)]. Comparisons were made using Wilcoxon rank-sum and chi(2) tests. Of the 8,309 patients with complete data, 5,503 (66%) had MI, 1,686 (20%) had EMI, and 1,120 (13%) had no MI. Treatment patterns prior to enrolment were similar among EMI and MI patients [aspirin (88 vs. 86%), beta-blockers (62 vs. 61%), heparin (83 vs. 81%), and glycoprotein IIb/IIIa inhibitors (23 vs. 24%)]. Similar rates of percutaneous coronary intervention (48 vs. 50%) and coronary artery bypass grafting (21 vs. 22%) were seen after enrolment. Patients presenting with MI had a higher rate of death or recurrent MI compared with patients with EMI [16 vs. 13%, adjusted OR 1.22 (95% CI 1.04, 1.44)].
  
  
  CONCLUSIONS
  Initial treatment patterns were similar among patients with EMI and MI in the SYNERGY trial. Patients with EMI had lower rates of death or re-infarction at 30 days compared with patients presenting with positive troponin results.
authors.affiliation: Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA. cmiller@wfubmc.edu
authors.forename: Chadwick D
authors.initials: CD
authors.lastname: Miller
authors.forename: Anindita
authors.initials: A
authors.lastname: Banerjee
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.forename: Michael C
authors.initials: MC
authors.lastname: Kontos
authors.forename: Gregory
authors.initials: G
authors.lastname: Fermann
authors.forename: Charles V
authors.initials: CV
authors.lastname: Pollack
authors.forename: Elliott
authors.initials: E
authors.lastname: Antman
authors.forename: Philip
authors.initials: P
authors.lastname: Aylward
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.forename: Renato
authors.initials: R
authors.lastname: Santos
authors.forename: James J
authors.initials: JJ
authors.lastname: Ferguson
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: James W
authors.initials: JW
authors.lastname: Hoekstra
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D012008:Recurrence; D016896:Treatment Outcome; D014336:Troponin / Q000378:metabolism
chemical_list: D000319:Adrenergic beta-Antagonists; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014336:Troponin