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Prediction of one-year survival in high-risk patients with acute coronary syndromes: results from the SYNERGY trial.
J Gen Intern Med. 2008 Mar; 23(3):310-6.JG

Abstract

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 = 0.4). 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 = 0.82).

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.

Authors+Show Affiliations

Duke Clinical Research Institute, Durham, NC 27715, USA. mahaf002@mc.duke.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18196350

Citation

Mahaffey, Kenneth W., et al. "Prediction of One-year Survival in High-risk Patients With Acute Coronary Syndromes: Results From the SYNERGY Trial." Journal of General Internal Medicine, vol. 23, no. 3, 2008, pp. 310-6.
Mahaffey KW, Yang Q, Pieper KS, et al. Prediction of one-year survival in high-risk patients with acute coronary syndromes: results from the SYNERGY trial. J Gen Intern Med. 2008;23(3):310-6.
Mahaffey, K. W., Yang, Q., Pieper, K. S., Antman, E. M., White, H. D., Goodman, S. G., Cohen, M., Kleiman, N. S., Langer, A., Aylward, P. E., Col, J. J., Reist, C., Ferguson, J. J., & Califf, R. M. (2008). Prediction of one-year survival in high-risk patients with acute coronary syndromes: results from the SYNERGY trial. Journal of General Internal Medicine, 23(3), 310-6. https://doi.org/10.1007/s11606-007-0498-4
Mahaffey KW, et al. Prediction of One-year Survival in High-risk Patients With Acute Coronary Syndromes: Results From the SYNERGY Trial. J Gen Intern Med. 2008;23(3):310-6. PubMed PMID: 18196350.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prediction of one-year survival in high-risk patients with acute coronary syndromes: results from the SYNERGY trial. AU - Mahaffey,Kenneth W, AU - Yang,Qinghong, AU - Pieper,Karen S, AU - Antman,Elliott M, AU - White,Harvey D, AU - Goodman,Shaun G, AU - Cohen,Marc, AU - Kleiman,Neal S, AU - Langer,Anatoly, AU - Aylward,Philip E, AU - Col,Jacques J, AU - Reist,Craig, AU - Ferguson,James J, AU - Califf,Robert M, AU - ,, Y1 - 2008/01/15/ PY - 2007/03/22/received PY - 2007/12/17/accepted PY - 2007/09/07/revised PY - 2008/1/16/pubmed PY - 2008/3/14/medline PY - 2008/1/16/entrez SP - 310 EP - 6 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 23 IS - 3 N2 - 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 = 0.4). 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 = 0.82). 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. SN - 1525-1497 UR - https://www.unboundmedicine.com/medline/citation/18196350/Prediction_of_one_year_survival_in_high_risk_patients_with_acute_coronary_syndromes:_results_from_the_SYNERGY_trial_ L2 - https://dx.doi.org/10.1007/s11606-007-0498-4 DB - PRIME DP - Unbound Medicine ER -