Targeting Investigation and Treatment in Type 2 Myocardial Infarction
Background: Type 2 myocardial infarction occurs in the absence of atherothrombosis, due to myocardial oxygen supply or demand imbalance, often during another acute illness. It is common and associated with poor clinical outcomes. No randomized controlled trials are available to guide investigation o...
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Elsevier
2025-05-01
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| Series: | JACC: Advances |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772963X25001553 |
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| author | Caelan Taggart, MD Amy Ferry, BSc Stephanie Barker, BSc Kelly Williams, BSc Grace Souter, BSc Anda Bularga, MD Ryan Wereski, MD Michael J. McDermott, MD Michelle C. Williams, MD, PhD Jasper Boeddinghaus, MD Christopher White, BSc Jagdeep S. Singh, MD Keith Boath, BSc Takeshi Fujisawa, PhD Christopher Tuck, MSc Anny Briola, MSc Steff Lewis, PhD Atul Anand, MD, PhD Marc R. Dweck, MD, PhD David E. Newby, MD, DSc Rustam Al-Shahi Salman, MD, PhD Nicholas L. Mills, MD, PhD Andrew R. Chapman, MD, PhD |
| author_facet | Caelan Taggart, MD Amy Ferry, BSc Stephanie Barker, BSc Kelly Williams, BSc Grace Souter, BSc Anda Bularga, MD Ryan Wereski, MD Michael J. McDermott, MD Michelle C. Williams, MD, PhD Jasper Boeddinghaus, MD Christopher White, BSc Jagdeep S. Singh, MD Keith Boath, BSc Takeshi Fujisawa, PhD Christopher Tuck, MSc Anny Briola, MSc Steff Lewis, PhD Atul Anand, MD, PhD Marc R. Dweck, MD, PhD David E. Newby, MD, DSc Rustam Al-Shahi Salman, MD, PhD Nicholas L. Mills, MD, PhD Andrew R. Chapman, MD, PhD |
| author_sort | Caelan Taggart, MD |
| collection | DOAJ |
| description | Background: Type 2 myocardial infarction occurs in the absence of atherothrombosis, due to myocardial oxygen supply or demand imbalance, often during another acute illness. It is common and associated with poor clinical outcomes. No randomized controlled trials are available to guide investigation or treatment. Objectives: The authors assessed the feasibility of implementing a complex intervention of investigation and treatment for coronary and structural heart disease in patients with type 2 myocardial infarction. Methods: A pilot phase of a prospective randomized controlled trial was conducted. Process outcomes included the proportion of eligible patients approached, consented, and randomized. Adherence was defined as the number of recommended investigations and treatments administered at 90 days. Qualitative interviews explored reasons for participation and patient experience. Results: Between November 2022 and November 2023, 4,127 patients with increased cardiac troponin concentrations were screened across 3 sites, and 403 patients (10%) met inclusion criteria. One hundred and forty-three patients (35%) were eligible, 119 patients (83%) were approached, and 60 patients (42%, age 70 ± 10 years, 38% women) consented and randomized to the intervention (n = 28) or standard care (n = 32). Follow-up was complete in all participants. Adherence to recommendations was 90.7% (95% CI: 85.3%-96.1%). Patients highlighted variation in communication of the diagnosis and in trial investigation and management recommendations were potential barriers to participation. Conclusions: It is feasible to recruit and randomize patients with type 2 myocardial infarction to a complex intervention targeting coronary or structural heart disease. A multicenter trial with an optimized intervention is now required to inform practice. |
| format | Article |
| id | doaj-art-7008c9b5dd664756ba48005ac2e8aeba |
| institution | DOAJ |
| issn | 2772-963X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JACC: Advances |
| spelling | doaj-art-7008c9b5dd664756ba48005ac2e8aeba2025-08-20T03:13:46ZengElsevierJACC: Advances2772-963X2025-05-014510173810.1016/j.jacadv.2025.101738Targeting Investigation and Treatment in Type 2 Myocardial InfarctionCaelan Taggart, MD0Amy Ferry, BSc1Stephanie Barker, BSc2Kelly Williams, BSc3Grace Souter, BSc4Anda Bularga, MD5Ryan Wereski, MD6Michael J. McDermott, MD7Michelle C. Williams, MD, PhD8Jasper Boeddinghaus, MD9Christopher White, BSc10Jagdeep S. Singh, MD11Keith Boath, BSc12Takeshi Fujisawa, PhD13Christopher Tuck, MSc14Anny Briola, MSc15Steff Lewis, PhD16Atul Anand, MD, PhD17Marc R. Dweck, MD, PhD18David E. Newby, MD, DSc19Rustam Al-Shahi Salman, MD, PhD20Nicholas L. Mills, MD, PhD21Andrew R. Chapman, MD, PhD22BHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United Kingdom; Cardiovascular Research Institute, University Hospital Basel, University of Basel, Basel, SwitzerlandEdinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, United KingdomVictoria Hospital, Kirkcaldy, ScotlandVictoria Hospital, Kirkcaldy, ScotlandBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, United Kingdom; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United KingdomBHF Centre of Research Excellence, University of Edinburgh, Edinburgh, United Kingdom; Address for correspondence: Dr Andrew R. Chapman, BHF Centre for Research Excellence, University of Edinburgh, Room SU315, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB, United Kingdom.Background: Type 2 myocardial infarction occurs in the absence of atherothrombosis, due to myocardial oxygen supply or demand imbalance, often during another acute illness. It is common and associated with poor clinical outcomes. No randomized controlled trials are available to guide investigation or treatment. Objectives: The authors assessed the feasibility of implementing a complex intervention of investigation and treatment for coronary and structural heart disease in patients with type 2 myocardial infarction. Methods: A pilot phase of a prospective randomized controlled trial was conducted. Process outcomes included the proportion of eligible patients approached, consented, and randomized. Adherence was defined as the number of recommended investigations and treatments administered at 90 days. Qualitative interviews explored reasons for participation and patient experience. Results: Between November 2022 and November 2023, 4,127 patients with increased cardiac troponin concentrations were screened across 3 sites, and 403 patients (10%) met inclusion criteria. One hundred and forty-three patients (35%) were eligible, 119 patients (83%) were approached, and 60 patients (42%, age 70 ± 10 years, 38% women) consented and randomized to the intervention (n = 28) or standard care (n = 32). Follow-up was complete in all participants. Adherence to recommendations was 90.7% (95% CI: 85.3%-96.1%). Patients highlighted variation in communication of the diagnosis and in trial investigation and management recommendations were potential barriers to participation. Conclusions: It is feasible to recruit and randomize patients with type 2 myocardial infarction to a complex intervention targeting coronary or structural heart disease. A multicenter trial with an optimized intervention is now required to inform practice.http://www.sciencedirect.com/science/article/pii/S2772963X25001553coronary angiographyechocardiographysecondary preventiontype 2 myocardial infarctionuniversal definition |
| spellingShingle | Caelan Taggart, MD Amy Ferry, BSc Stephanie Barker, BSc Kelly Williams, BSc Grace Souter, BSc Anda Bularga, MD Ryan Wereski, MD Michael J. McDermott, MD Michelle C. Williams, MD, PhD Jasper Boeddinghaus, MD Christopher White, BSc Jagdeep S. Singh, MD Keith Boath, BSc Takeshi Fujisawa, PhD Christopher Tuck, MSc Anny Briola, MSc Steff Lewis, PhD Atul Anand, MD, PhD Marc R. Dweck, MD, PhD David E. Newby, MD, DSc Rustam Al-Shahi Salman, MD, PhD Nicholas L. Mills, MD, PhD Andrew R. Chapman, MD, PhD Targeting Investigation and Treatment in Type 2 Myocardial Infarction JACC: Advances coronary angiography echocardiography secondary prevention type 2 myocardial infarction universal definition |
| title | Targeting Investigation and Treatment in Type 2 Myocardial Infarction |
| title_full | Targeting Investigation and Treatment in Type 2 Myocardial Infarction |
| title_fullStr | Targeting Investigation and Treatment in Type 2 Myocardial Infarction |
| title_full_unstemmed | Targeting Investigation and Treatment in Type 2 Myocardial Infarction |
| title_short | Targeting Investigation and Treatment in Type 2 Myocardial Infarction |
| title_sort | targeting investigation and treatment in type 2 myocardial infarction |
| topic | coronary angiography echocardiography secondary prevention type 2 myocardial infarction universal definition |
| url | http://www.sciencedirect.com/science/article/pii/S2772963X25001553 |
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