ATOLL at 6 Months: Better Survival With Enoxaparin Persists

April 15, 2011

April 15, 2011 (New Orleans, Louisiana) — Six month results from the ATOLL study of enoxaparin in primary PCI have shown that the strong trend toward a reduction in mortality observed at 30 days in the enoxaparin group persists over longer follow-up.

Dr Gilles Montalescot

The latest results from the ATOLL trial were reported by lead investigator Dr Gilles Montalescot (Hôpital Pitié-Salpêtrière, Paris, France) at the American College of Cardiology 2011 Scientific Sessions last week.

The ATOLL study randomized 910 patients undergoing PCI for acute STEMI to receive either intravenous enoxaparin or unfractionated heparin (UFH) with the procedure. The main results, reported at last year's European Society of Cardiology, showed no significant difference in the primary end point--the 30-day rate of death/MI complications/procedural failure/major bleeding--between the two groups, although the enoxaparin group showed a strong favorable trend. In addition there was a significant improvement in the enoxaparin group in many of the secondary end points, including death/complications of MI. All-cause death showed a strong trend toward benefit in the enoxaparin group, and this remained out to six months.

ATOLL: All-Cause Mortality Over Six Months

Time Enoxaparin (%) UFH (%) Difference (%)
1 mo 3.8 6.3 2.5
3 mo 4.5 7.0 2.5
6 mo 4.7 7.2 2.5

Montalescot also presented results of a meta-analysis of four studies comparing enoxaparin (0.5 mg/kg IV) with unfractionated heparin in a total of 6242 PCI patients (ATOLL, STEEPLE, FINESSE, and Brieger studies) which suggested significant benefits of the low-molecular-weight heparin.

Meta-Analysis of Four PCI Studies: Risk of Major End Points With Enoxaparin vs UFH

End point Odds Ratio 95% CI p
Death 0.68 0.51–0.91 0.009
Death/MI 0.75 0.60–0.93 0.009
Major bleeding 0.66 0.50–0.88 0.006
Net clinical benefit 0.74 0.62–0.86 <0.001

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