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(Circulation. 1999;99:1127-1131.)
© 1999 American Heart Association, Inc.

Cardiovascular News

Meeting Highlights

Highlights of the 20th Congress of the European Society of Cardiology

James J. Ferguson, MD

From St Luke's Episcopal Hospital, Texas Heart Institute, Baylor College of Medicine, The University of Texas Health Science Center at Houston.

The following studies were presented at the 20th Congress of the European Society of Cardiology, August 22–26, 1998, in Vienna, Austria.

Acute Coronary Syndromes

TIMI 11B
Presenter: Elliott Antman, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.

The study: A large-scale (200 centers, 10 countries), randomized, controlled trial comparing unfractionated heparin with low-molecular-weight heparin (enoxaparin) in patients with unstable angina and non–Q-wave infarction. Patients were randomized to intravenous unfractionated heparin (70-U/kg bolus, 15 U · kg^-1 · h^-1 titrated to activated partial thromboplastin times [aPTTs]) of 1.5 to 2x control; n=1957) or enoxaparin (30-mg IV bolus, 1 mg/kg SC every 12 hours; n=1953). In-hospital therapy was continued for 2 to 8 days. After discharge, patients in the unfractionated-heparin group received placebo and enoxaparin patients continued active therapy through 43 days. Initially, unstable angina patients could be enrolled in the study if they had a known history of coronary artery disease or had documented ECG changes (ST-segment depression) or positive cardiac markers. Ten months into the study, because of a lower-than-projected outcome event rate, the inclusion criteria were amended to include only the higher-risk group with documented ECG changes or elevated serum cardiac markers. At the end of the trial, 83% of patients enrolled had these high-risk characteristics. All patients received aspirin. The primary end point of the study was the composite incidence of death/MI and urgent, ischemia-driven revascularization.

The results: At 14 days, primary outcome events occurred in 14.2% of the patients taking enoxaparin and 16.7% of those taking unfractionated heparin (P=0.029). . . . [Full Text of this Article]