Treatment and outcomes of patients with evolving myocardial infarction: Experiences from the SYNERGY trial

Chadwick D. Miller, Anindita Banerjee, Kenneth W. Mahaffey, Michael C. Kontos, Gregory Fermann, Charles V. Pollack, Elliott Antman, Philip Aylward, Shaun G. Goodman, Renato Santos, James J. Ferguson, Robert M. Califf, James W. Hoekstra

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Aims: 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. Methods and 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 ≥ 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 χ2 tests. Of the 8309 patients with complete data, 5503 (66%) had MI, 1686 (20%) had EMI, and 1120 (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)]. Conclusion: 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.

Original languageEnglish
Pages (from-to)1079-1084
Number of pages6
JournalEuropean heart journal
Issue number9
Publication statusPublished or Issued - May 2007
Externally publishedYes


  • Evolving myocardial infarction
  • Initial treatment
  • Outcomes
  • Troponin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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