Population Health Research Institute
Acute Coronary Syndromes

Acute Coronary Syndromes
Testing new anti-clotting therapies to prevent heart attacks

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The most common presentation of heart attacks or pre-heart attacks, also known as myocardial infarction (MI), and one of the common medical emergencies can be attributed to acute coronary syndrome (ACS). Characterized by severe chest pain, unstable angina and non-Q-wave MI, patients with ACS are at high risk of dying or developing a new heart attack or stroke.


Overview

The ACS Research Program at the Population Health Research Institute is one of the largest programs in the world focusing on the evaluation of new antithrombotic agents and other strategies to improve outcomes in patients with unstable angina/non-ST elevation myocardial infarction (MI) and ST segment elevation myocardial infarction (STEMI). Its goals are to; evaluate new and current antithrombotic therapies in patients with ACS, evaluate invasive procedure and their role in the management of patients with ACS and to understand the interaction between antithrombotic therapies and invasive procedures in ACS.


Key Discoveries

The OASIS program, consisting of 8 randomized trials and involving more than 100,000 patients, is one of the most influential clinical trial programs in the world. It has led to the approval of new therapies (such as clopidogrel and fondaparinux) and helped to better understand the relationship between efficacy and safety of antithrombotic drugs.  


Studies



Main Publications

Organization to Assess strategies for Ischemic Syndromes (OASIS-2) Trial Investigators. Effects of recombinant hirudin (lepirudin) compared to heparin in preventing death, myocardial infarction, refractory angina and revascularization procedures in patients with acute myocardial ischemia without ST elevation: A large international randomized double blind study. Lancet 1999; 353: 429-438.

Eikelboom JW, Anand SS, Mehta SR, Weitz JI, Yi C, Yusuf S. Prognostic significance of thrombocytopenia during hirudin and heparin therapy in acute coronary syndrome without ST elevation: Organization to Assess Strategies for Ischemic Syndromes (OASIS-2) Study. Circulation 2001; 103(5): 643-650.

Mehta SR, Chrolavicius S, Afzal R, Pogue J. Granger CB, Budaj A, Peters RJ, Bassand JP, Wallentin L, Joyner C, Fox KA, for the OASIS-6 Trial Group. Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 randomized trial. JAMA 2006; 295: 1519-1530.

Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med 2006; 354(14): 1464-1476. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KAA for the CURE Investigators. The Clopidogrel in Unstable angina to prevent Recurrent Events Trial (CURE) Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345: 494-502.

Mehta SR, Yusuf S, Peters RJG, Bertrand ME, Lewis BS, Natarajan MK, Malmberg K, Rupprecht H-J, Zhao F, Chrolavicius S, Copland I and Fox KAA for the Clopidogrel in Unstable angina to prevent Recurrent Events trial (CURE) Investigators. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet 2001; 358: 527-533

Yusuf S, Mehta SR for the CREATE Trial Group Investigators. Effects of reviparin, a low-molecular-weight heparin, on mortality, reinfarction, and strokes in patients with acute myocardial infarction presenting with ST-segment elevation.JAMA 2005; 293(4): 427-436

Mehta SR, Yusuf S, Diaz R, Zhu J, Pais P, Xavier D, Paolasso E, Ahmed R, Xie C, Kazmi K, Tai J, Orlandini A, Pogue, J, Liu L for the CREATE-ECLA Trial Group Investigators. Effect of Glucose-Insulin-Potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction. JAMA 2005; 293(4): 437-446

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Population Health Research Institute • Hamilton, Ontario • information@phri.ca