The Association Between HsTrop and Tachyarrhythmias (STRIPE-MI)
Research type
Research Study
Full title
The Association Between HsTrop and Tachyarrhythmias: Type 1 or Type 2 MI? (STRIPE-MI)
IRAS ID
206061
Contact name
Nick Curzen
Contact email
Sponsor organisation
University Hospitals Southampton NHS Foundation Trust
Duration of Study in the UK
0 years, 2 months, 1 days
Research summary
Troponin is the "gold standard" blood test used in current clinical practice to help establish the diagnosis of a heart attack. Specifically, a heart attack has been defined as a rise in cardiac troponin (cTn) above a critical level. With improvements in technology there are now cTn assays which are more sensitive and allow clinicians to rule out heart attacks early, they are known as Highly Sensitive Troponin assays (HsTrop).
There are different forms of heart attacks. There is the classical form or type 1 myocardial infarction (T1MI). T1MI has been defined as a troponin rise related to an acute blockage of a heart artery in a suspected heart attack. The evidence for early use of medication and coronary stents of T1MI in medium to high risk individuals is robust. The second form of heart attack or type 2 myocardial infarction (T2MI) has been defined as a troponin rise secondary to an increased oxygen demand or reduced oxygen supply. Examples of clinical scenarios giving rise to T2MI include anaemia, fast heart rhythms and coronary artery spasm. The advent of the contemporary HsTrop assay has led to increase in the diagnosis of T2MI. However, there is no evidence to treat a T2MI in the same way that a T1MI is treated in terms of medication and invasive procedures such as stent implantation.
A particularly common dilemma for clinicians is the optimal management of patients presenting with a fast heart rhythm and troponin rise. A simplistic view would be to define troponin rises associated with a fast heart rhythm as evidence of T1MI and therefore manage these patients as such. This is a flawed approach which could put patients at unnecessary risk.
The aim of the study is to retrospectively:
a)Describe the relationship between fast heart rhythms and HsTrop elevations.
b)Assess the proportion of patients presenting with fast heart rhythm who have T1MI versus T2MI.
c)Describe the management of such cases and to attempt to adjudicate whether there are cases undergoing ‘unnecessary’ invasive procedures.REC name
South East Scotland REC 01
REC reference
16/SS/0194
Date of REC Opinion
21 Nov 2016
REC opinion
Favourable Opinion