Randomized trial of low molecular weight heparin (enoxaparin) versus unfractionated heparin for unstable coronary artery disease - One-year results of the ESSENCE study

OBJECTIVES We sought to determine whether the observed benefits of enoxapar in were maintained beyond the early phase; a one-year follow-up survey was undertaken for patients enrolled in the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q wave Coronary Events (ESSENCE) study. BACKGROUND We have previously reported a significant benefit of low molecul ar weight as compared with unfractionated heparin (UFH) in the 14- and 30-d ay incidence of a composite end point of death, myocardial infarction (MI) or recurrent angina in patients with unstable angina or non-Q wave MI. METHODS The study recruited 3,171 patients with recent-onset rest angina an d underlying ischemic heart disease. All patients received oral aspirin dai ly and were randomized to receive enoxaparin subcutaneously every 12 h or U FH (intravenous bolus followed by continuous infusion) in a double-blind, d ouble-dummy fashion for a median of 2.6 days. RESULTS The incidence of the composite triple end point at one year was low er among patients receiving enoxaparin as compared with those receiving UFH (32.0% vs. 35.7%, p = 0.022), with a trend toward a lower incidence of the secondary composite end point of death or MI (11.5% vs. 13.5%, p = 0.082). At one year, the need for diagnostic catheterization and coronary revascul arization was lower in the enoxaparin group (55.8% vs. 59.4%, p = 0.036 and 35.9% vs. 41.2%, p = 0.002, respectively). CONCLUSIONS In patients with unstable angina or non-Q wave MI, enoxaparin t herapy significantly reduced the rates of recurrent ischemic events and inv asive diagnostic and therapeutic procedures in the short term with sustaine d benefit at one year.(C) 2000 by the American College of Cardiology.