Effect of Classic Secondary Prevention in Type 2 MI: A Target Trial Emulation Study

Summary

A classic heart attack is caused by a blockage to the coronary arteries that supplies the heart muscle with oxygenated blood. The medical term for this condition is type 1 myocardial infarction. There is strong scientific evidence that the usage of pharmacological drugs such as statins, beta blockers, Renin-Angiotensin-Aldosterone System blockers and platelet inhibitors after a type 1 myocardial infarction improves survival and reduces the risk for new myocardial infarctions. However, a myocardial infarction may also occur without blockage to the coronary arteries when other acute conditions causes either a decreased supply or an increased demand of oxygenated blood to the heart. The medical term for the latter is type 2 myocardial infarction. There are currently no scientific evidence that any pharmacological drug improves survival in patients with a type 2 myocardial infarction, of whom only one in three patients are alive after five years.

The aim of this study is to investigate if those drugs that improves the prognosis after a type 1 myocardial infarction (Beta blockers, Renin-Angiotensin-Aldosterone System blockers, Statins and platelet inhibitors) also affects the prognosis after a type 2 myocardial infarction.

The best way to answer this question would be to conduct clinical trials for each drug where type 2 myocardial infarction patients are randomized to either receiving the drug of interest or receiving placebo (sugar pills) and then compare the survival and outcomes in both groups over time.

However, clinical trials are costly, time consuming and also difficult to conduct with type 2 myocardial infarction patients since these patients are treated at various hospital departments.

Therefore, this study will instead include patients in a Swedish national register for myocardial infarction, in which myocardial infarction patients are reported from all Swedish hospitals, and compare type 2 myocardial infarction patients that did receive or did not receive each treatment. To minimize the risk of making inaccurate conclusions about the causal relationship between treatment and outcome, the study will define the optimal clinical trial for each treatment and then specifically emulate these trials in all possible aspects using the register data. This method is called "target trial emulation".

Conditions

• Myocardial Infarction Type 2

Interventions

DRUG

Beta Blocker Therapy or No Therapy (Control)

Beta blocker therapy or no Beta blocker therapy initiated after type 2 myocardial infarction

DRUG

RAAS blocker Therapy or No therapy (Control)

RAAS blocker therapy or no RAAS blocker therapy initiated after type 2 myocardial infarction

DRUG

Statin Therapy or No Therapy (Control)

Statin therapy or no Statin therapy initiated after type 2 myocardial infarction

DRUG

Single Antiplatelet Therapy or No Therapy (Control)

Single Antiplatelet Therapy or no antiplatelet therapy initiated after type 2 myocardial infarction

DRUG

Dual Antiplatelet Therapy or No Therapy (Control)

Dual Antiplatelet Therapy or no Dual Antiplatelet Therapy initiated after type 2 myocardial infarction

Sponsors & Collaborators

• Uppsala University

  lead OTHER

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2010-09-03

Primary Completion

2022-05-05

Completion

2022-05-05

FDA Drug

Yes

Countries

• Sweden

Study Locations