Targeting Investigation and Treatment in Patients With Type 2 Myocardial Infarction

Summary

Type 2 myocardial infarction (MI) is common and associated with poor clinical outcomes, with as many as one in ten experiencing recurrent MI within one year, and only one in three alive at five years. Recent prospective data demonstrates two-thirds of patients with type 2 MI have underlying coronary artery disease and one-third have left ventricular systolic impairment. Importantly, this is previously unrecognised in over half of all patients, suggesting there may be opportunities to identify and treat these underlying conditions to modify clinical outcomes. The investigators will undertake a pilot randomised controlled trial in which patients will be randomised to standard care or a complex intervention involving detailed cardiology assessment for the likelihood of coronary disease or left ventricular impairment, followed by targeted investigation and treatment where underlying disease is identified. This study will inform the design and delivery of a prospective multi-centre randomised controlled trial powered for clinical outcomes.

Conditions

• Myocardial Infarction Type 2

Interventions

DIAGNOSTIC_TEST

Coronary computed tomography angiography

CT scan of the heart arteries

DIAGNOSTIC_TEST

Invasive coronary angiography

Invasive coronary angiography via the radial or femoral approach

DIAGNOSTIC_TEST

Transthoracic echocardiography

Ultrasound scan of the heart

DIAGNOSTIC_TEST

Cardiac MRI scan

An MRI scan to assess the heart structure and function

DRUG

Antiplatelet Drug (Aspirin or Statin)

Antiplatelet therapy for coronary artery disease

DRUG

Anticoagulants (Apixaban, Edoxaban, Rivaroxoban, Warfarin)

Anticoagulant therapy if atrial fibrillation identified (DOAC or Warfarin)

DRUG

Guideline directed heart failure therapy

Use of guideline approved heart failure treatments (ACE-inhibitor / angiotensin receptor blocker (ARB) / ARB and neprilysin inhibitor, mineralocorticoid receptor antagonist, beta blocker, SGLT-2 inhibitor, diuretic therapy)

DRUG

Statins (Cardiovascular Agents)

Statins will be recommended for patients with coronary plaque disease or hypercholesterolaemia

Sponsors & Collaborators

• Chief Scientist Office of the Scottish Government

  collaborator OTHER_GOV

• University of Edinburgh

  lead OTHER

Principal Investigators

• Andrew Chapman, MBChB PhD · University of Edinburgh

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

30 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2022-11-14

Primary Completion

2024-06-30

Completion

2024-06-30

Countries

• United Kingdom

Study Locations