Obesity in patients with non-ST-segment elevation acute coronary syndromes: results from the SYNERGY trial.

Obese patients are at increased risk of acute coronary syndromes (ACS). We evaluated the prevalence of obesity in a large ACS population, as well as the relationship between body mass index (BMI) and the use of cardiac medications and procedures, clinical outcomes, and treatment effects between enoxaparin and unfractionated heparin (UFH). Using the database of the SYNERGY trial, we identified 9978 patients in 12 countries who were randomly assigned to receive enoxaparin or UFH. Patient weight at baseline and 30-day follow-up was recorded. BMI information was available on 9837 patients. BMI was analyzed in clinically meaningful categories (<20, 20-25, 30-35, > or =35 kg/m(2)) and as a continuous variable. Thirty-two percent of patients were obese (BMI> or =30), with a greater proportion of patients with obesity from North America (36%) compared with other regions. Enoxaparin was dosed as 1 mg/kg regardless of body weight without maximum. The first dose of enoxaparin was underdosed in 15% of patients assigned enoxaparin, and obese patients were more likely to be underdosed than non-obese patients. Obese patients were younger, less often white, had more diabetes, hypertension, hyperlipidemia, family history of coronary artery disease, and congestive heart failure but fewer strokes, less peripheral vascular disease, and less often smoked. After adjustment, increased BMI was not an independent predictor of bleeding outcomes or 30-day death/myocardial infarction (MI), but increased BMI was predictive of lower 1-year mortality in the subgroup of patients with BMI at baseline below approximately 30 kg/m(2). No statistical interaction term was observed between obesity and randomized therapy for the outcomes of death/MI at 30 days and 6 months; death at 30 days, 6 months, and 1 year; and GUSTO or TIMI bleeding. Nearly one third of patients in SYNERGY were obese. Despite multiple comorbidities, obese patients had better unadjusted short- and long-term outcomes. After adjustment, higher BMI was not an independent predictor of in-hospital bleeding events or 30-day death/MI, but increased BMI was an independent predictor of 1-year mortality in patients with lower BMI but not in heavier patients. No interaction between the randomized treatment and obesity for efficacy and safety outcomes was observed across the range of BMI in this dataset. Standard dosing of enoxaparin should be used in patients without extreme obesity due to limited outcome data in these patients.

Mahaffey KW ，Tonev ST ，Spinler SA ，Levine GN ，Gallo R ，Ducas J ，Goodman SG ，Antman EM ，Becker RC ，Langer A ，White HD ，Aylward PE ，Col JJ ，Ferguson JJ ，Califf RM ，SYNERGY Trial Investigators ... -  《-》

Outcomes in elderly patients with acute coronary syndromes randomized to enoxaparin vs. unfractionated heparin: results from the SYNERGY trial.

Lopes RD ，Alexander KP ，Marcucci G ，White HD ，Spinler S ，Col J ，Aylward PE ，Califf RM ，Mahaffey KW ... -  《-》

Prediction of one-year survival in high-risk patients with acute coronary syndromes: results from the SYNERGY trial.

Mahaffey KW ，Yang Q ，Pieper KS ，Antman EM ，White HD ，Goodman SG ，Cohen M ，Kleiman NS ，Langer A ，Aylward PE ，Col JJ ，Reist C ，Ferguson JJ ，Califf RM ，SYNERGY Trial Investigators ... -  《-》

Efficacy and safety of enoxaparin compared with unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention in the Superior Yield of the New Strategy of Enoxaparin, Revas

White HD ，Kleiman NS ，Mahaffey KW ，Lokhnygina Y ，Pieper KS ，Chiswell K ，Cohen M ，Harrington RA ，Chew DP ，Petersen JL ，Berdan LG ，Aylward PE ，Nessel CC ，Ferguson JJ 3rd ，Califf RM ... -  《-》

Smoking status and antithrombin therapy in patients with non-ST-segment elevation acute coronary syndrome.

Leung S ，Gallup D ，Mahaffey KW ，Cohen M ，Antman EM ，Goodman SG ，Harrington RA ，Langer A ，Aylward P ，Ferguson JJ ，Califf RM ，SYNERGY Trial Investigators ... -  《-》