Sykes, R. , Briscoe, M., Krystofiak, T., Peck, O., Mangion, K. and Berry, C. (2021) Type 2 myocardial infarction and myocardial injury: eligibility for novel medical therapy to de-risk clinical trials. Open Heart, 8, e001633. (doi: 10.1136/openhrt-2021-001633) (PMID:34083388) (PMCID:PMC8174491)
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Abstract
Background Patients with type 2 myocardial infarction (T2MI) and other mechanisms of nonthrombotic myocardial injury have an unmet therapeutic need. Eligibility for novel medical therapy is generally uncertain. Methods We predefined colchicine, eplerenone and ticagrelor as candidates for repurposing towards novel therapy for T2MI or myocardial injury. Considering eligibility for randomisation in a clinical trial, each drug was classified according to indications and contraindications for therapy and survival for at least 24 hours following admission. Eligibility criteria for prescription were evaluated against the Summary of Medical Product Characteristics. Consecutive hospital admissions were screened to identify patients with ≥1 high-sensitivity troponin-I value >99th percentile. Endotypes of myocardial injury were adjudicated according to the Fourth Universal Definition of MI. Patients’ characteristics and medication were prospectively evaluated. Results During 1 March to 15 April 2020, 390 patients had a troponin I>URL. Reasons for exclusion: type 1 MI n=115, indeterminate diagnosis n=42, lack of capacity n=14, death <24 hours n=7, duplicates n=2. Therefore, 210 patients with T2MI/myocardial injury and 174 (82.8%) who survived to discharge were adjudicated for treatment eligibility. Patients who fulfilled eligibility criteria initially on admission and then at discharge were colchicine 25/210 (11.9%) and 23/174 (13.2%); eplerenone 57/210 (27.1%) and 45/174 (25.9%); ticagrelor 122/210 (58.1%) and 98/174 (56.3%). Forty-six (21.9%) and 38 (21.8%) patients were potentially eligible for all three drugs on admission and discharge, respectively. Conclusion A reasonably high proportion of patients may be considered eligible for repurposing novel medical therapy in secondary prevention trials of type 2 MI/myocardial injury.
Item Type: | Articles |
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Additional Information: | Funding Professor Colin Berry is supported by research funding from the British Heart Foundation (PG/17/2532884; RE/13/5/30177; RE/18/6/34217) and Medical Research Council (UKRI/MRC MR/S018905/1). |
Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Mangion, Dr Kenneth and Sykes, Dr Robert and Berry, Professor Colin |
Authors: | Sykes, R., Briscoe, M., Krystofiak, T., Peck, O., Mangion, K., and Berry, C. |
College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
Journal Name: | Open Heart |
Publisher: | BMJ |
ISSN: | 2053-3624 |
ISSN (Online): | 2053-3624 |
Published Online: | 02 June 2021 |
Copyright Holders: | Copyright © Author(s) (or their employer(s)) 2021 |
First Published: | First published in Open Heart 2021 |
Publisher Policy: | Reproduced under a Creative Commons licence |
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