Plaque Erosion Pilot Study (PEPS)
Research type
Research Study
Full title
Plaque Erosion Pilot Study: A single centre, prospective observational pilot study comparing the molecular biology of plaque rupture and plaque erosion in patients with ST elevation myocardial infarction undergoing Primary PCI.
IRAS ID
161361
Contact name
Alisdair Ryding
Contact email
Sponsor organisation
Norfolk and Norwich University Hospital
Duration of Study in the UK
1 years, 5 months, 2 days
Research summary
Heart attacks occur when an artery supplying blood to the heart is suddenly blocked by a blood clot. Usually the artery is diseased due to a build up of fatty material within the vessel wall: this is known as atherosclerosis. About 70% of heart attacks are due to a process called plaque rupture: tissue covering the fatty material suddenly bursts and causes a blood clot to form, blocking normal blood flow. The processes that cause this are relatively well understood: inflammation and tissue degradation within the atherosclerotic plaque lead to plaque rupture. The other 30% of cases are due to a process called plaque erosion: this is characterised by the loss of the endothelial lining of the artery, again causing clot formation. The processes leading to plaque erosion are almost completely unknown.
We propose to study the molecular differences of plaque rupture and plaque erosion in patients presenting to hospital with heart attacks (acute myocardial infarction). Patients requiring emergency treatment to unblock the heart artery (known as primary percutaneous coronary intervention: PPCI) routinely undergo removal of the blood clot (thrombus aspiration) to restore blood flow, prior to implantation of a stent. We plan to store the blood clot for histological analysis, and the associated blood for molecular analysis. The underlying cause of the heart attack (erosion or rupture) will be determined by undertaking detailed imaging of the atherosclerotic plaque by a technique called Optical Coherence Tomography (OCT). This is often used to guide PCI procedures, but is not routine.
We are particularly interested in differences in inflammatory signals known as cytokines, and enzymes that weaken tissue known as matrix metalloproteinases (MMPs).
Results will be correlated with the underlying plaque pathology. Potentially, a better understanding of the events that trigger plaque erosion could lead to new targets for heart attack treatment.REC name
London - Camden & Kings Cross Research Ethics Committee
REC reference
14/LO/1901
Date of REC Opinion
24 Nov 2014
REC opinion
Further Information Favourable Opinion