Clinical InvestigationAcute Ischemic Heart DiseaseRandomized evaluation of the efficacy of enoxaparin versus unfractionated heparin in high-risk patients with non–ST-segment elevation acute coronary syndromes receiving the glycoprotein IIb/IIIa inhibitor eptifibatide. Long-term results of the Integrilin and Enoxaparin Randomized Assessment of Acute Coronary Syndrome Treatment (INTERACT) trial
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Patient group
The entry criteria for enrollment, the study design, treatment protocol, and end point definitions have been described previously.6 The INTERACT trial randomized 746 patients at 50 centers in Canada, with rest ischemic symptoms within the past 24 hours. In addition, patients had ST-segment deviation (ST depression >0.1 mV or transient ST-segment elevation) and/or elevated serum biomarkers (troponin I or T >3× the upper reference level or creatine kinase–MB [CK-MB] greater than normal). Written
Short-term outcome
As reported previously,6 patients randomized to receive enoxaparin had a significantly lower 30-day incidence of death or MI compared with those receiving UFH (5% vs 9%, P = .031). There was also a trend to a lower composite end point of death, MI, or recurrent angina in patients with adjudicated ECG changes in the enoxaparin-treated group (9% vs 12.6%, P = .11).
Long-term follow-up
Of the 746 patients enrolled in the trial, 24 died within the 30-day follow-up period. Consequently, there were potentially 722
Discussion
These findings represent the longest term follow-up available to date in a randomized trial comparing enoxaparin and UFH in ACS. The trial demonstrates that when using aspirin and eptifibatide in high-risk patients with NSTE ACS, the early use of enoxaparin is associated with a sustained improvement of long-term clinical outcomes, including death or MI.
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Cited by (25)
Acute myocardial infarction: STEMI and NSTEMI
2018, Cardiovascular Thrombus: From Pathology and Clinical Presentations to Imaging, Pharmacotherapy and InterventionsComparison of bleeding complications and one-year survival of low molecular weight heparin versus unfractioned heparin for acute myocardial infarction in elderly patients. the FAST-MI registry
2013, International Journal of CardiologyCitation Excerpt :As regards major bleeding, however, most data from the literature did not find a significantly increased risk associated with the use of LMWH, although an increase in minor bleeding has been reported [12–17]. In patients with non-STEMI most clinical studies and their meta-analyses have demonstrated that LMWH (mainly enoxaparin) compounds are an effective and safe alternative to UFH, with a clinical benefit maintained over the long-term [21,16–20]. The patients included in these trials, however, were notably younger than in the present study (mean age 64 years in ESSENCE, 66 years in TIMI 11B) [12,16,17].
Adverse Drug Reactions in Patients with Cardiovascular Disease
2008, Current Problems in CardiologyBleeding and outcome in acute coronary syndrome: Insights from continuous electrocardiogram monitoring in the Integrilin and Enoxaparin Randomized Assessment of Acute Coronary Syndrome Treatment (INTERACT) trial
2008, American Heart JournalCitation Excerpt :Furthermore, our sensitivity analyses should add to the robustness of our conclusion. Not all recruiting sites participated in the extended follow-up of patients, although their baseline characteristics were similar to those of the remaining cohort.25 Because of the small number of major bleeding events, we had inadequate power to reliably differentiate the prognostic impact of bleeding alone versus blood transfusion.
Conflicts of interest: Drs Fitchett, Langer, Armstrong, and Goodman have received research grant support, speaker honoraria, or consultant fees from Aventis Canada, Key Pharmaceuticals, Division of Schering Canada Inc, and Millenium Pharmaceuticals.