RapidNSTEMI
Research type
Research Study
Full title
A randomised controlled trial of very early angiography +/-intervention versus standard care on outcomes in patients with non ST-elevation myocardial infarction
IRAS ID
233921
Contact name
Anthony Gershlick
Contact email
Sponsor organisation
University Hospitals of Leicester NHS Trust
Duration of Study in the UK
13 years, 1 months, 1 days
Research summary
Heart attacks are common. They may be major or minor. The smaller heart attack occurs when blood clot forms on narrowings in the coronary arteries and then cause either partial blockage of the artery supplying blood to the heart, or completely block the artery but only do so intermittently. If they are not treated appropriately then the artery may block completely which can result in a poor outcome (such as major heart attack or death). Published Guidelines tell us therefore that these small heart attacks need to be treated. Such patients are therefore admitted to hospital, given drugs to prevent more clot forming, and within 3-4 days, are taken to the catheter laboratory (a special X ray room) where any narrowings in the coronary arteries can be seen on the X ray screen and treated,where necessary, with a balloon and stent (angioplasty).
We are able to detect that there has been a heart attack by the release of small amounts of protein from injured heart muscle – these proteins are known as “troponins” and they can be measured using a blood test. Recently, it has been possible to detect small amounts of troponins in the blood very early after admission in patients with small heart attacks. Hence, we are now able to determine how severe the heart attack is according to the blood levels of early measured troponins. If we put these measured levels into an App programme together with some patient details such as age and kidney function, we come up with a score that tells us what the future risk to the patient is. If the calculated score is high this suggests it may be better to treat this type of patient much earlier with balloon and stent than is currently undertaken, although this has never been proven. Alternatively, patients may be better left for longer on the medical treatment until the angioplasty. In this study we are therefore comparing the strategy of going to the cath lab early and treating if necessary with going to the cath lab according to current standard timings.
The outcomes that we will measure to test whether very early angioplasty in higher risk patients is actually beneficial will be: death, further heart attack or heart failure occurring over the subsequent 12 months of follow up. We will also undertake a special cardiac heart scan called an MRI to see if the heart attack is smaller with earlier angioplasty.REC name
East of England - Cambridge East Research Ethics Committee
REC reference
18/EE/0222
Date of REC Opinion
5 Sep 2018
REC opinion
Further Information Favourable Opinion