Abstract 2865: Impact of Enoxaparin on Thrombus Formation, Coronary Blood Flow, and Myocardial Perfusion After Early Invasive Treatment During Acute Coronary Syndrome: Results from the SYNERGY Library
Background: Enoxaparin, an Xa-inhibitor precursor, was shown to be safe and non-inferior (death and myocardial infarction) at 30 days compared with unfractionated heparin (UFH) in the treatment of high-risk patients with ACS in the SYNERGY trial. Whether enoxaparin affects angiographic coronary and myocardial perfusion is not known.
Methods: Among 9978 ACS patients randomized to subcutaneous enoxaparin or intravenous UFH in the SYNERGY trial, 256 consecutive patients underwent blinded angiographic analysis at an independent core lab as part of the SYNERGY Library. Intention-to-treat analysis included complete quantitative and qualitative assessment of the coronary tree, including TIMI flow and frame count and myocardial blush grade (MBG, previously validated with KAPPA 0.78).
Results: Baseline clinical characteristics were comparable among both groups. UFH patients had more moderate/severe calcification (22.4 vs. 6.8%, p=0.0146), but there were similar rates of lesion ulceration (7.5 vs. 11.9%, p=0.40). Angiographic results are shown in the table⇓. At 30 days, the unadjusted rates of death or MI were 5.7% in enoxaparin vs. 9.1% in UFH subgroups (p=0.35).
Conclusions: In this substudy of the SYNERGY trial, despite the fact that post-PCI TIMI-3 flow was lower with enoxaparin than UFH, TIMI frame counts, myocardial perfusion, and residual thrombus were similar with both anticoagulants.