Redefining Unstable Angina with High-sensitivity Cardiac Troponin

用高灵敏度心肌肌钙蛋白重新定义不稳定型心绞痛

基本信息

  • 批准号:
    MR/V007017/1
  • 负责人:
  • 金额:
    $ 19.13万
  • 依托单位:
  • 依托单位国家:
    英国
  • 项目类别:
    Fellowship
  • 财政年份:
    2021
  • 资助国家:
    英国
  • 起止时间:
    2021 至 无数据
  • 项目状态:
    已结题

项目摘要

Most people who come to hospital with chest pain do not have a heart attack, but still need to have a blood test to measure a protein called troponin which is released when the heart is damaged. We recently found that by using a more sensitive troponin test we can identify people without a heart attack at a very early stage, and most can be safely discharged home from the Emergency Department. This test is so sensitive it can measure troponin in nearly all people at very low levels. We have found that very small amounts of troponin, even when below the levels used to diagnose a heart-attack, can predict future heart attack and death. We think this is because low-levels of troponin are due to unstable disease of the heart arteries and that this information will help us identify people with a condition called unstable angina more accurately. We wish to use this information to identify those at the highest risk of future heart attack and evaluate whether further testing and treatment for heart artery disease will reduce this risk. To do this we will carry out three research studies. In the first study we will review data collected from a previous trial, and investigate how we can define these patients who have the highest risk, and who we believe have a new definition of unstable angina. At the same time, in Study 2, we will also assess if the blood troponin level can predict abnormalities on CT scan of the heart. We will also assess if there are extra protein markers in the blood of patients who have the highest risk of future heart-attacks. In Study 3, we will then investigate if we can reduce the risk of heart attacks in those patients who meet our new definition of unstable angina, by starting them on treatments like aspirin or statins if they have disease on a CT of their heart. Study 3 will be a randomised control trial across 6 hospitals in Scotland, meaning half of the patients recruited will not get a scan, and not have new drugs started. This will allow us to assess if doing these extra scans and starting extra medication has a significant and real benefit for patients.
大多数因胸痛来医院的人并没有心脏病发作,但仍然需要进行血液检查以测量心脏受损时释放的一种名为肌钙蛋白的蛋白质。我们最近发现,通过使用更敏感的肌钙蛋白测试,我们可以在非常早期的阶段识别没有心脏病发作的人,并且大多数人可以从急诊室安全出院回家。这个测试是如此敏感,它可以测量肌钙蛋白在几乎所有的人在非常低的水平。我们发现,即使肌钙蛋白水平低于用于诊断心脏病发作的水平,也可以预测未来的心脏病发作和死亡。我们认为这是因为低水平的肌钙蛋白是由于不稳定的心脏动脉疾病,这一信息将帮助我们更准确地识别患有不稳定型心绞痛的人。我们希望利用这些信息来识别那些未来心脏病发作风险最高的人,并评估进一步的心脏动脉疾病检测和治疗是否会降低这种风险。为此,我们将开展三项研究。在第一项研究中,我们将回顾从以前的试验中收集的数据,并调查我们如何定义这些具有最高风险的患者,以及我们认为具有不稳定型心绞痛新定义的患者。同时,在研究2中,我们还将评估血液肌钙蛋白水平是否可以预测心脏CT扫描的异常。我们还将评估未来心脏病发作风险最高的患者血液中是否有额外的蛋白质标记物。在研究3中,我们将研究是否可以降低符合我们新定义的不稳定型心绞痛患者的心脏病发作风险,如果他们在心脏CT上有疾病,则开始服用阿司匹林或他汀类药物。研究3将是一项在苏格兰6家医院进行的随机对照试验,这意味着招募的一半患者将不会接受扫描,也不会开始使用新药。这将使我们能够评估是否做这些额外的扫描和开始额外的药物治疗有一个显着的和真实的好处的病人。

项目成果

期刊论文数量(9)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
Influence of Age on the Diagnosis of Myocardial Infarction.
  • DOI:
    10.1161/circulationaha.122.059994
  • 发表时间:
    2022-10-11
  • 期刊:
  • 影响因子:
    37.8
  • 作者:
    Lowry MTH;Doudesis D;Wereski R;Kimenai DM;Tuck C;Ferry AV;Bularga A;Taggart C;Lee KK;Chapman AR;Shah ASV;Newby DE;Mills NL;Anand A;High-STEACS Investigators
  • 通讯作者:
    High-STEACS Investigators
Validation of the myocardial-ischaemic-injury-index machine learning algorithm to guide the diagnosis of myocardial infarction in a heterogenous population: a prespecified exploratory analysis.
  • DOI:
    10.1016/s2589-7500(22)00025-5
  • 发表时间:
    2022-05
  • 期刊:
  • 影响因子:
    0
  • 作者:
    Doudesis D;Lee KK;Yang J;Wereski R;Shah ASV;Tsanas A;Anand A;Pickering JW;Than MP;Mills NL;High-STEACS Investigators
  • 通讯作者:
    High-STEACS Investigators
Sex differences in investigations and outcomes among patients with type 2 myocardial infarction.
  • DOI:
    10.1136/heartjnl-2021-319118
  • 发表时间:
    2021-09
  • 期刊:
  • 影响因子:
    0
  • 作者:
    Kimenai DM;Lindahl B;Chapman AR;Baron T;Gard A;Wereski R;Meex SJR;Jernberg T;Mills NL;Eggers KM
  • 通讯作者:
    Eggers KM
High-Sensitivity Cardiac Troponin on Presentation to Rule Out Myocardial Infarction: A Stepped-Wedge Cluster Randomized Controlled Trial.
  • DOI:
    10.1161/circulationaha.120.052380
  • 发表时间:
    2021-06-08
  • 期刊:
  • 影响因子:
    37.8
  • 作者:
    Anand A;Lee KK;Chapman AR;Ferry AV;Adamson PD;Strachan FE;Berry C;Findlay I;Cruikshank A;Reid A;Collinson PO;Apple FS;McAllister DA;Maguire D;Fox KAA;Newby DE;Tuck C;Harkess R;Keerie C;Weir CJ;Parker RA;Gray A;Shah ASV;Mills NL;HiSTORIC Investigators†
  • 通讯作者:
    HiSTORIC Investigators†
Assessment of Oxygen Supply-Demand Imbalance and Outcomes Among Patients With Type 2 Myocardial Infarction: A Secondary Analysis of the High-STEACS Cluster Randomized Clinical Trial.
  • DOI:
    10.1001/jamanetworkopen.2022.20162
  • 发表时间:
    2022-07-01
  • 期刊:
  • 影响因子:
    13.8
  • 作者:
    Bularga, Anda;Taggart, Caelan;Mendusic, Filip;Kimenai, Dorien M.;Wereski, Ryan;Lowry, Matthew T. H.;Lee, Kuan K.;Ferry, Amy V.;Stewart, Stacey S.;McAllister, David A.;Shah, Anoop S. V.;Anand, Atul;Newby, David E.;Mills, Nicholas L.;Chapman, Andrew R.
  • 通讯作者:
    Chapman, Andrew R.
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Ryan Wereski其他文献

APPLICATION OF THE UNIVERSAL DEFINITION OF MYOCARDIAL INFARCTION IN PRACTICE
  • DOI:
    10.1016/s0735-1097(23)01736-9
  • 发表时间:
    2023-03-07
  • 期刊:
  • 影响因子:
  • 作者:
    Caelan Taggart;Dorothea Kimenai;Erik Kadesjo;Atul Anand;Anda Bularga;Ryan Wereski;Dimitrios Doudesis;Matthew Lowry;Kuan Ken Lee;Andrew R. Chapman;Gustaf Edgren;Andreas Roos;Nicholas L. Mills
  • 通讯作者:
    Nicholas L. Mills
SOCIOECONOMIC DEPRIVATION AND CARDIOVASCULAR RISK IN PATIENTS ENROLLED IN THE SCOT-HEART TRIAL
  • DOI:
    10.1016/s0735-1097(23)01689-3
  • 发表时间:
    2023-03-07
  • 期刊:
  • 影响因子:
  • 作者:
    Ryan Wereski;Philip D. Adamson;Marc Dweck;Nicholas L. Mills;David E. Newby;Michelle C. Williams
  • 通讯作者:
    Michelle C. Williams
DERIVATION AND VALIDATION OF A RISK STRATIFICATION TOOL IN PATIENTS WITH TYPE 2 MYOCARDIAL INFARCTION
  • DOI:
    10.1016/s0735-1097(22)01974-x
  • 发表时间:
    2022-03-08
  • 期刊:
  • 影响因子:
  • 作者:
    Caelan Taggart;Karla Monterrubio-Gomez;Andreas Roos;Erik Kadesjo;Dorothea Kimenai;Anda Bularga;Ryan Wereski;Martin Holzmann;Nicholas L. Mills;Catalina Vallejos;Andrew R. Chapman
  • 通讯作者:
    Andrew R. Chapman
UNIFORM AND SEX-SPECIFIC CARDIAC TROPONIN THRESHOLDS TO RULE OUT MYOCARDIAL INFARCTION AT PRESENTATION
  • DOI:
    10.1016/s0735-1097(24)03280-7
  • 发表时间:
    2024-04-02
  • 期刊:
  • 影响因子:
  • 作者:
    Ziwen Li;Ryan Wereski;Atul Anand;Matthew Lowry;Dimitrios Doudesis;Chris Tuck;Anoop S. Shah;Nicholas L. Mills;Dorothea Kimenai
  • 通讯作者:
    Dorothea Kimenai
Coronary CT angiography-guided management of patients with stable chest pain: 10-year outcomes from the SCOT-HEART randomised controlled trial in Scotland
冠状动脉 CT 血管造影指导的稳定型胸痛患者管理:苏格兰 SCOT-HEART 随机对照试验的 10 年结果
  • DOI:
    10.1016/s0140-6736(24)02679-5
  • 发表时间:
    2025-01-25
  • 期刊:
  • 影响因子:
    88.500
  • 作者:
    Michelle C Williams;Ryan Wereski;Christopher Tuck;Philip D Adamson;Anoop S V Shah;Edwin J R van Beek;Giles Roditi;Colin Berry;Nicholas Boon;Marcus Flather;Steff Lewis;John Norrie;Adam D Timmis;Nicholas L Mills;Marc R Dweck;David E Newby;Michelle C Williams;Ryan Wereski;Christopher Tuck;Philip Adamson;Tracey Steedman
  • 通讯作者:
    Tracey Steedman

Ryan Wereski的其他文献

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