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1. Machine Learning for Myocardial Infarction Compared With Guideline-Recommended Diagnostic Pathways

Author

Boeddinghaus, Jasper, Doudesis, Dimitrios, Lopez-Ayala, Pedro, Lee, Kuan Ken, Koechlin, Luca, Wildi, Karin, Nestelberger, Thomas, Borer, Raphael, Miró, Òscar, Martin-Sanchez, F. Javier, Strebel, Ivo, Rubini Giménez, Maria, Keller, Dagmar I., Christ, Michael, Bularga, Anda, Li, Ziwen, Ferry, Amy V., Tuck, Chris, Anand, Atul, Gray, Alasdair, Mills, Nicholas L., Mueller, Christian, Richards, A. Mark, Pemberton, Chris, Troughton, Richard W., Aldous, Sally J., Brown, Anthony F.T., Dalton, Emily, Hammett, Chris, Hawkins, Tracey, O’Kane, Shanen, Parke, Kate, Ryan, Kimberley, Schluter, Jessica, Barker, Stephanie, Blades, Jennifer, Chapman, Andrew R., Fujisawa, Takeshi, Kimenai, Dorien M., McDermott, Michael, Newby, David E., Schulberg, Stacey D., Shah, Anoop S.V., Sorbie, Andrew, Soutar, Grace, Strachan, Fiona E., Taggart, Caelan, Vicencio, Daniel Perez, Wang, Yiqing, Wereski, Ryan, Williams, Kelly, Weir, Christopher J., Berry, Colin, Reid, Alan, Maguire, Donogh, Collinson, Paul O., Sandoval, Yader, Smith, Stephen W., Wussler, Desiree, Muench-Gerber, Tamar, Glaeser, Jonas, Spagnuolo, Carlos, Huré, Gabrielle, Gehrke, Juliane, Puelacher, Christian, Gualandro, Danielle M., Shrestha, Samyut, Kawecki, Damian, Morawiec, Beata, Muzyk, Piotr, Buergler, Franz, Buser, Andreas, Rentsch, Katharina, Twerenbold, Raphael, López, Beatriz, Martinez-Nadal, Gemma, Adrada, Esther Rodriguez, Parenica, Jiri, and von Eckardstein, Arnold

Published
2024
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2. Uniform or Sex-Specific Cardiac Troponin Thresholds to Rule Out Myocardial Infarction at Presentation

Author

Mills, Nicholas L., Strachan, Fiona E., Tuck, Christopher, Anand, Atul, Akinlade, Olawale Mathias, Barker, Stephanie, Blades, Jennifer, Boeddinghaus, Jasper, Bularga, Anda, de Bakker, Marie, Chapman, Andrew R., Doudesis, Dimitrios, Ferry, Amy V., Fujisawa, Takeshi, Georgiev, Konstantin, Kimenai, Dorien M., Lee, Kuan Ken, Lyell, Iona, Li, Ziwen, Lowry, Matthew TH., McKinlay, Lynn, McDermott, Michael, McPherson, Jean, Mendusic, Filip, Sorbie, Andrew, Souter, Grace, Schulberg, Stacey D., Taggart, Caelan, Thurston, Alexander JF., Tew, Yong Yong, Perez-Vicencio, Daniel, Wang, Yiqing, Wereski, Ryan, Williams, Kelly, Newby, David E., Fox, Keith AA., Berry, Colin, Walker, Simon, Weir, Christopher J., Ford, Ian, Gray, Alasdair, Collinson, Paul O., Apple, Fred S., Reid, Alan, Cruikshank, Anne, Findlay, Iain, Amoils, Shannon, McAllister, David A., Maguire, Donogh, Stevens, Jennifer, Norrie, John, Shah, Anoop SV., Andrews, Jack PM., Adamson, Philip D., Moss, Alastair, Anwar, Mohamed S., Hung, John, Malo, Jonathan, Fischbacher, Colin M., Croal, Bernard L., Leslie, Stephen J., Keerie, Catriona, Parker, Richard A., Walker, Allan, Harkess, Ronnie, Wackett, Tony, Weir, Christopher, Armstrong, Roma, Stirling, Laura, MacDonald, Claire, Sadat, Imran, Finlay, Frank, Harrison, Kathy, Linksted, Pamela, Lavenberg, Stephen, Lowry, Matthew T.H., Tuck, Chris, and Shah, Anoop S.V.

Published
2024
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3. Trajectories of cardiac troponin in the decades before cardiovascular death: a longitudinal cohort study

Author

Kimenai, Dorien M., Anand, Atul, de Bakker, Marie, Shipley, Martin, Fujisawa, Takeshi, Lyngbakken, Magnus N., Hveem, Kristian, Omland, Torbjørn, Valencia-Hernández, Carlos A., Lindbohm, Joni V., Kivimaki, Mika, Singh-Manoux, Archana, Strachan, Fiona E., Shah, Anoop S. V., Kardys, Isabella, Boersma, Eric, Brunner, Eric J., and Mills, Nicholas L.

Published
2023
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4. Uniform or Sex-Specific Cardiac Troponin Thresholds to Rule Out Myocardial Infarction at Presentation

Author

Li, Ziwen, primary, Wereski, Ryan, additional, Anand, Atul, additional, Lowry, Matthew T.H., additional, Doudesis, Dimitrios, additional, McDermott, Michael, additional, Ferry, Amy V., additional, Tuck, Chris, additional, Chapman, Andrew R., additional, Lee, Kuan Ken, additional, Shah, Anoop S.V., additional, Mills, Nicholas L., additional, Kimenai, Dorien M., additional, Strachan, Fiona E., additional, Tuck, Christopher, additional, Akinlade, Olawale Mathias, additional, Barker, Stephanie, additional, Blades, Jennifer, additional, Boeddinghaus, Jasper, additional, Bularga, Anda, additional, de Bakker, Marie, additional, Fujisawa, Takeshi, additional, Georgiev, Konstantin, additional, Lyell, Iona, additional, Li, Ziwen, additional, Lowry, Matthew TH., additional, McKinlay, Lynn, additional, McPherson, Jean, additional, Mendusic, Filip, additional, Sorbie, Andrew, additional, Souter, Grace, additional, Schulberg, Stacey D., additional, Taggart, Caelan, additional, Thurston, Alexander JF., additional, Tew, Yong Yong, additional, Perez-Vicencio, Daniel, additional, Wang, Yiqing, additional, Williams, Kelly, additional, Newby, David E., additional, Fox, Keith AA., additional, Berry, Colin, additional, Walker, Simon, additional, Weir, Christopher J., additional, Ford, Ian, additional, Gray, Alasdair, additional, Collinson, Paul O., additional, Apple, Fred S., additional, Reid, Alan, additional, Cruikshank, Anne, additional, Findlay, Iain, additional, Amoils, Shannon, additional, McAllister, David A., additional, Maguire, Donogh, additional, Stevens, Jennifer, additional, Norrie, John, additional, Shah, Anoop SV., additional, Andrews, Jack PM., additional, Adamson, Philip D., additional, Moss, Alastair, additional, Anwar, Mohamed S., additional, Hung, John, additional, Malo, Jonathan, additional, Fischbacher, Colin M., additional, Croal, Bernard L., additional, Leslie, Stephen J., additional, Keerie, Catriona, additional, Parker, Richard A., additional, Walker, Allan, additional, Harkess, Ronnie, additional, Wackett, Tony, additional, Weir, Christopher, additional, Armstrong, Roma, additional, Stirling, Laura, additional, MacDonald, Claire, additional, Sadat, Imran, additional, Finlay, Frank, additional, Harrison, Kathy, additional, Linksted, Pamela, additional, and Lavenberg, Stephen, additional

Published
2024
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5. High-sensitivity cardiac troponin and the diagnosis of myocardial infarction in patients with kidney impairment

Author

Mills, Nicholas L., Strachan, Fiona E., Tuck, Christopher, Shah, Anoop S.V., Anand, Atul, Bularga, Anda, Wereski, Ryan, Lowry, Matthew T.H., Taggart, Caelan, Ferry, Amy V., Lee, Kuan Ken, Chapman, Andrew R., Sandeman, Dennis, Adamson, Philip D., Stables, Catherine L., Vallejos, Catalina A., Tsanas, Athanasios, Marshall, Lucy, Stewart, Stacey D., Fujisawa, Takeshi, McPherson, Jean, McKinlay, Lynn, Newby, David E., Fox, Keith A.A., Berry, Colin, Walker, Simon, Weir, Christopher J., Ford, Ian, Gray, Alasdair, Collinson, Paul O., Apple, Fred S., Reid, Alan, Cruikshank, Anne, Findlay, Iain, Amoils, Shannon, McAllister, David A., Maguire, Donogh, Stevens, Jennifer, Norrie, John, Andrews, Jack P.M., Moss, Alastair, Anwar, Mohamed S., Hung, John, Malo, Jonathan, Fischbacher, Colin M., Croal, Bernard L., Leslie, Stephen J., Keerie, Catriona, Parker, Richard A., Walker, Allan, Harkess, Ronnie, Wackett, Tony, Weir, Christopher, Armstrong, Roma, Stirling, Laura, MacDonald, Claire, Sadat, Imran, Finlay, Frank, Charles, Heather, Linksted, Pamela, Young, Stephen, Alexander, Bill, Duncan, Chris, Gallacher, Peter J., Miller-Hodges, Eve, Farrah, Tariq E., Halbesma, Nynke, Blackmur, James P., Cruickshank, Anne, and Dhaun, Neeraj

Published
2022
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6. 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

Author

Mills, Nicholas L, Strachan, Fiona E, Tuck, Christopher, Shah, Anoop SV, Anand, Atul, Chapman, Andrew R, Ferry, Amy V, Lee, Kuan Ken, Doudesis, Dimitrios, Bularga, Anda, Wereski, Ryan, Taggart, Caelan, Lowry, Matthew TH, Mendusic, Filip, Kimenai, Dorien M, Sandeman, Dennis, Adamson, Philip D, Stables, Catherine L, Vallejos, Catalina A, Tsanas, Athanasios, Marshall, Lucy, Stewart, Stacey D, Fujisawa, Takeshi, Hautvast, Mischa, McPherson, Jean, McKinlay, Lynn, Ford, Ian, Newby, David E, Fox, Keith AA, Berry, Colin, Walker, Simon, Weir, Christopher J, Gray, Alasdair, Collinson, Paul O, Apple, Fred S, Reid, Alan, Cruikshank, Anne, Findlay, Iain, Amoils, Shannon, McAllister, David A, Maguire, Donogh, Stevens, Jennifer, Norrie, John, Andrews, Jack PM, Moss, Alastair, Anwar, Mohamed S, Hung, John, Malo, Jonathan, Fischbacher, Colin, Croal, Bernard L, Leslie, Stephen J, Keerie, Catriona, Parker, Richard A, Walker, Allan, Harkess, Ronnie, Wackett, Tony, Armstrong, Roma, Stirling, Laura, MacDonald, Claire, Sadat, Imran, Finlay, Frank, Charles, Heather, Linksted, Pamela, Young, Stephen, Alexander, Bill, Duncan, Chris, Yang, Jason, Shah, Anoop S V, Pickering, John W, and Than, Martin P

Published
2022
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7. Implementation of a high sensitivity cardiac troponin I assay and risk of myocardial infarction or death at five years: observational analysis of a stepped wedge, cluster randomised controlled trial

Author

Lee, Kuan Ken, primary, Doudesis, Dimitrios, additional, Ferry, Amy V, additional, Chapman, Andrew R, additional, Kimenai, Dorien M, additional, Fujisawa, Takeshi, additional, Bularga, Anda, additional, Lowry, Matthew T H, additional, Taggart, Caelan, additional, Schulberg, Stacey, additional, Wereski, Ryan, additional, Tuck, Chris, additional, Strachan, Fiona E, additional, Newby, David E, additional, Anand, Atul, additional, Shah, Anoop S V, additional, and Mills, Nicholas L, additional

Published
2023
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8. Sex-Specific Thresholds of High-Sensitivity Troponin in Patients With Suspected Acute Coronary Syndrome

Author

Mills, Nicholas L., Strachan, Fiona E., Tuck, Christopher, Shah, Anoop S.V., Anand, Atul, Ferry, Amy V., Lee, Kuan Ken, Chapman, Andrew R., Sandeman, Dennis, Adamson, Philip D., Stables, Catherine L., Vallejo, Catalina A., Tsanasis, Athanasios, Marshall, Lucy, Stewart, Stacey D., Fujisawa, Takeshi, Hautvast, Mischa, McPherson, Jean, McKinlay, Lynn, Newby, David E., Fox, Keith A.A., Berry, Colin, Walker, Simon, Weir, Christopher J., Ford, Ian, Gray, Alasdair, Collinson, Paul O., Apple, Fred S., Reid, Alan, Cruikshank, Anne, Findlay, Iain, Amoils, Shannon, McAllister, David A., Maguire, Donogh, Stevens, Jennifer, Norrie, John, Weir, Christopher, Andrews, Jack P.M., Moss, Alastair, Anwar, Mohamed S., Hung, John, Malo, Jonathan, Fischbacher, Colin M., Croal, Bernard L., Leslie, Stephen J., Keerie, Catriona, Parker, Richard A., Walker, Allan, Harkess, Ronnie, Wackett, Tony, Armstrong, Roma, Flood, Marion, Stirling, Laura, MacDonald, Claire, Sadat, Imran, Finlay, Frank, Charles, Heather, Linksted, Pamela, Young, Stephen, Alexander, Bill, Duncan, Chris, Kimenai, Dorien M., Meex, Steven J.R., Cruickshank, Anne, and Tuck, Chris

Published
2019
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10. Implementation of a high sensitivity cardiac troponin I assay and risk of myocardial infarction or death at five years: observational analysis of a stepped wedge, cluster randomised controlled trial.

Author

Kuan Ken Lee, Doudesis, Dimitrios, Ferry, Amy V., Chapman, Andrew R., Kimenai, Dorien M., Takeshi Fujisawa, Bularga, Anda, Lowry, Matthew T. H., Taggart, Caelan, Schulberg, Stacey, Wereski, Ryan, Tuck, Chris, Strachan, Fiona E., Newby, David E., Anand, Atul, Shah, Anoop S. V., and Mills, Nicholas L.

Subjects
MYOCARDIAL infarction risk factors, MORTALITY risk factors, TROPONIN, EVALUATION of medical care, SCIENTIFIC observation, CONFIDENCE intervals, ACUTE coronary syndrome, TERTIARY care, HUMAN services programs, RISK assessment, SEX distribution, DESCRIPTIVE statistics, RESEARCH funding, SECONDARY care (Medicine), SECONDARY analysis, PROPORTIONAL hazards models
Published
2023
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11. High-Sensitivity Cardiac Troponin and the Universal Definition of Myocardial Infarction

Author

Chapman, Andrew R., Adamson, Philip D., Shah, Anoop S.V., Anand, Atul, Strachan, Fiona E., Ferry, Amy V., Ken Lee, Kuan, Berry, Colin, Findlay, Iain, Cruikshank, Anne, Reid, Alan, Gray, Alasdair, Collinson, Paul O., Apple, Fred, McAllister, David A., Maguire, Donogh, Fox, Keith A.A., Vallejos, Catalina A., Keerie, Catriona, Weir, Christopher J., Newby, David E., and Mills, Nicholas L.

Published
2020
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14. Additional file 1 of Trajectories of cardiac troponin in the decades before cardiovascular death: a longitudinal cohort study

Author

Kimenai, Dorien M., Anand, Atul, de Bakker, Marie, Shipley, Martin, Fujisawa, Takeshi, Lyngbakken, Magnus N., Hveem, Kristian, Omland, Torbjørn, Valencia-Hernández, Carlos A., Lindbohm, Joni V., Kivimaki, Mika, Singh-Manoux, Archana, Strachan, Fiona E., Shah, Anoop S. V., Kardys, Isabella, Boersma, Eric, Brunner, Eric J., and Mills, Nicholas L.

Abstract

Additional file 1: Supplementary Appendix. Principle of joint modelling. Table S1. Clinical characteristics of study population at first, second and third troponin measurement. Table S2. Association between clinical characteristics and longitudinal cardiac troponin I. Table S3. Baseline characteristics of those who experienced an event. Table S4. Association between the cardiac troponin I level at baseline and cardiovascular death. Table S5. Baseline characteristics of individuals without cardiac disease at baseline. Table S6. Association between the temporal evolution of cardiac troponin I and cardiovascular death in individuals without cardiac disease at baseline. Table S7. The longitudinal cardiac troponin’s accuracy. Table S8. Association between serial cardiac troponin measurements and cardiovascular death in HUNT. Fig S1. Study flow diagram. Fig S2. Cardiac troponin I levels at baseline, 10 years and 15 years, stratified by sex and age groups. Fig S3. Trajectories of cardiac troponin I with 95% confidence intervals before non-cardiovascular death occurred or at end of follow-up. Fig S4. Trajectories of cardiac troponin I with 95% confidence intervals before cardiovascular death or non-cardiovascular death occurred or at end of follow-up. Fig S5. Trajectories of cardiac troponin I with 95% confidence intervals before cardiac death occurred or at end of follow-up. Fig S6. Trajectories of cardiac troponin I with 95% confidence intervals before non-fatal myocardial infarction, fatal myocardial infarction and no myocardial infarction event. Fig S7. Trajectories of cardiac troponin I with 95% confidence intervals in individuals without baseline cardiac disease before cardiovascular death occurred or at end of follow-up. Fig S8. Trajectories of cardiac troponin I with 95% confidence intervals before cardiovascular death and death from any causein HUNT.

Published
2023
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15. High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study

Author

Shah, Anoop S V, Anand, Atul, Sandoval, Yader, Lee, Kuan Ken, Smith, Stephen W, Adamson, Philip D, Chapman, Andrew R, Langdon, Timothy, Sandeman, Dennis, Vaswani, Amar, Strachan, Fiona E, Ferry, Amy, Stirzaker, Alexandra G, Reid, Alan, Gray, Alasdair J, Collinson, Paul O, McAllister, David A, Apple, Fred S, Newby, David E, and Mills, Nicholas L

Published
2015
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17. 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

Author

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., Strachan, Fiona E, Tuck, Christopher, Doudesis, Dimitrios, Sandeman, Dennis, Adamson, Philip D, Andrews, Jack P M, Moss, Alastair, Anwar, Mohamed S, Hung, John, Stables, Catherine L, Vallejo, Catalina A, Tsanas, Athanasios, Marshal, Lucy, Fujisawa, Takeshi, Hautvast, Mischa, McPherson, Jean, McKinley, Lynn, Fox, Keith A A, Berry, Colin, Walker, Simon, Weir, Christopher, Ford, Ian, Gray, Alasdair, Collinson, Paul O, Apple, Fred S, Reid, Alan, Cruikshank, Anne, Findlay, Iain, Amoils, Shannon, Maguire, Donogh, Stevens, Jennifer, Norrie, John, Malo, Jonathan, Fischbacher, Colin M, Croal, Bernard L, Leslie, Stephen J, Keerie, Catriona, Parker, Richard A, Walker, Allan, Harkess, Ronnie, Wackett, Tony, Armstrong, Roma, Flood, Marion, Stirling, Laura, MacDonald, Claire, Sadat, Imran, Finlay, Frank, Charles, Heather, Linksted, Pamela, Young, Stephen, Alexander, Bill, and Duncan, Chris

Abstract

Importance: Type 2 myocardial infarction occurs owing to multiple factors associated with myocardial oxygen supply-demand imbalance, which may confer different risks of adverse outcomes.\ud \ud Objective: To evaluate the prevalence and outcomes of different factors associated with oxygen supply-demand imbalance among patients with type 2 myocardial infarction.\ud \ud Design, Setting, and Participants: In this secondary analysis of a stepped-wedge, cluster randomized clinical trial conducted at 10 secondary and tertiary care hospitals in Scotland, 6096 patients with an adjudicated diagnosis of type 1 or type 2 myocardial infarction from June 10, 2013, to March 3, 2016, were identified, and the findings were reported on August 28, 2018. The trial enrolled consecutive patients with suspected acute coronary syndrome. The diagnosis of myocardial infarction was adjudicated according to the Fourth Universal Definition of Myocardial Infarction and the primary factor associated with oxygen supply-demand imbalance in type 2 myocardial infarction was defined. This secondary analysis was not prespecified. Statistical analysis was performed from July 7 to 30, 2020.\ud \ud Intervention: Implementation of a high-sensitivity cardiac troponin I assay.\ud \ud Main Outcomes and Measures: All-cause death at 1 year according to the factors associated with oxygen supply-demand imbalance among patients with type 2 myocardial infarction.\ud \ud Results: Of 6096 patients (2602 women [43%]; median age, 70 years [IQR, 58-80 years]), 4981 patients had type 1 myocardial infarction, and 1115 patients had type 2 myocardial infarction. The most common factor associated with oxygen supply-demand imbalance was tachyarrhythmia (616 of 1115 [55%]), followed by hypoxemia (219 of 1115 [20%]), anemia (95 of 1115 [9%]), hypotension (89 of 1115 [8%]), severe hypertension (61 of 1115 [5%]), and coronary mechanisms (35 of 1115 [3%]). At 1 year, all-cause mortality occurred for 15% of patients (720 of 4981) with type 1 myocardial infarction and 23% of patients (285 of 1115) with type 2 myocardial infarction. Compared with patients with type 1 myocardial infarction, those with type 2 myocardial infarction owing to hypoxemia (adjusted odds ratio [aOR], 2.35; 95% CI, 1.72-3.18) and anemia (aOR, 1.83; 95% CI, 1.14-2.88) were at greatest risk of death, whereas those with type 2 myocardial infarction owing to tachyarrhythmia (aOR, 0.83; 95% CI, 0.65-1.06) or coronary mechanisms (aOR, 1.07; 95% CI, 0.17-3.86) were at similar risk of death as patients with type 1 myocardial infarction.\ud \ud Conclusions and Relevance: In this secondary analysis of a randomized clinical trial, mortality after type 2 myocardial infarction was associated with the underlying etiologic factor associated with oxygen supply-demand imbalance. Most type 2 myocardial infarctions were associated with tachyarrhythmia, with better prognosis, whereas hypoxemia and anemia accounted for one-third of cases, with double the mortality of type 1 myocardial infarction. These differential outcomes should be considered by clinicians when determining which cases need to be managed if patient outcomes are to improve.\ud \ud Trial Registration: ClinicalTrials.gov Identifier: NCT01852123.

Published
2022

18. High-sensitivity cardiac troponin and the diagnosis of myocardial infarction in patients with renal impairment

Author

Gallacher, Peter J., Miller-Hodges, Eve, Shah, Anoop S.V., Farrah, Tariq E., Halbesma, Nynke, Blackmur, James P., Chapman, Andrew R., Adamson, Philip D., Anand, Atul, Strachan, Fiona E., Ferry, Amy V., Lee, Kuan Ken, Berry, Colin, Findlay, Iain, Cruickshank, Anne, Reid, Alan, Gray, Alasdair, Collinson, Paul O., Apple, Fred S., McAllister, David A., Maguire, Donogh, Fox, Keith A.A., Keerie, Catriona, Weir, Christopher J., Newby, David E., Mills, Nicholas L., Dhaun, Neeraj, and High-STEACS investigators

Abstract

The benefit and utility of high-sensitivity cardiac troponin (hs-cTn) in the diagnosis of myocardial infarction in patients with kidney impairment is unclear. Here, we describe implementation of hs-cTnI testing on the diagnosis, management, and outcomes of myocardial infarction in patients with and without kidney impairment. Consecutive patients with suspected acute coronary syndrome enrolled in a stepped-wedge, cluster-randomized controlled trial were included in this pre-specified secondary analysis. Kidney impairment was defined as an eGFR under 60mL/min/1.73m . The index diagnosis and primary outcome of type 1 and type 4b myocardial infarction or cardiovascular death at one year were compared in patients with and without kidney impairment following implementation of hs-cTnI assay with 99th centile sex-specific diagnostic thresholds. Serum creatinine concentrations were available in 46,927 patients (mean age 61years; 47% women), of whom 9,080 (19%) had kidney impairment. hs-cTnIs were over 99th centile in 46% and 16% of patients with and without kidney impairment. Implementation increased the diagnosis of type 1 infarction from 12.4% to 17.8%, and from 7.5% to 9.4% in patients with and without kidney impairment (both significant). Patients with kidney impairment and type 1 myocardial infarction were less likely to undergo coronary revascularisation (26% versus 53%) or receive dual anti-platelets (40% versus 68%) than those without kidney impairment, and this did not change post-implementation. In patients with hs-cTnI above the 99th centile, the primary outcome occurred twice as often in those with kidney impairment compared to those without (24% versus 12%, hazard ratio 1.53, 95% confidence interval 1.31 to 1.78). Thus, hs-cTnI testing increased the identification of myocardial injury and infarction but failed to address disparities in management and outcomes between those with and without kidney impairment.

Published
2022

19. High-sensitivity cardiac troponin and the diagnosis of myocardial infarction in patients with kidney impairment

Author

Gallacher, Peter J., primary, Miller-Hodges, Eve, additional, Shah, Anoop S.V., additional, Farrah, Tariq E., additional, Halbesma, Nynke, additional, Blackmur, James P., additional, Chapman, Andrew R., additional, Adamson, Philip D., additional, Anand, Atul, additional, Strachan, Fiona E., additional, Ferry, Amy V., additional, Lee, Kuan Ken, additional, Berry, Colin, additional, Findlay, Iain, additional, Cruickshank, Anne, additional, Reid, Alan, additional, Gray, Alasdair, additional, Collinson, Paul O., additional, Apple, Fred S., additional, McAllister, David A., additional, Maguire, Donogh, additional, Fox, Keith A.A., additional, Keerie, Catriona, additional, Weir, Christopher J., additional, Newby, David E., additional, Mills, Nicholas L., additional, Dhaun, Neeraj, additional, Tuck, Christopher, additional, Bularga, Anda, additional, Wereski, Ryan, additional, Lowry, Matthew T.H., additional, Taggart, Caelan, additional, Sandeman, Dennis, additional, Stables, Catherine L., additional, Vallejos, Catalina A., additional, Tsanas, Athanasios, additional, Marshall, Lucy, additional, Stewart, Stacey D., additional, Fujisawa, Takeshi, additional, McPherson, Jean, additional, McKinlay, Lynn, additional, Walker, Simon, additional, Ford, Ian, additional, Cruikshank, Anne, additional, Amoils, Shannon, additional, Stevens, Jennifer, additional, Norrie, John, additional, Andrews, Jack P.M., additional, Moss, Alastair, additional, Anwar, Mohamed S., additional, Hung, John, additional, Malo, Jonathan, additional, Fischbacher, Colin M., additional, Croal, Bernard L., additional, Leslie, Stephen J., additional, Parker, Richard A., additional, Walker, Allan, additional, Harkess, Ronnie, additional, Wackett, Tony, additional, Weir, Christopher, additional, Armstrong, Roma, additional, Stirling, Laura, additional, MacDonald, Claire, additional, Sadat, Imran, additional, Finlay, Frank, additional, Charles, Heather, additional, Linksted, Pamela, additional, Young, Stephen, additional, Alexander, Bill, additional, and Duncan, Chris, additional

Published
2022
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22. Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome

Author

Chapman, Andrew R., Lee, Kuan Ken, McAllister, David A., Cullen, Louise, Greenslade, Jaimi H., Parsonage, William, Worster, Andrew, Kavsak, Peter A., Blankenberg, Stefan, Neumann, Johannes, Söerensen, Nils A., Westermann, Dirk, Buijs, Madelon M., Verdel, Gerard J. E., Pickering, John W., Than, Martin P., Twerenbold, Raphael, Badertscher, Patrick, Sabti, Zaid, Mueller, Christian, Anand, Atul, Adamson, Philip, Strachan, Fiona E., Ferry, Amy, Sandeman, Dennis, Gray, Alasdair, Body, Richard, Keevil, Brian, Carlton, Edward, Greaves, Kim, Korley, Frederick K., Metkus, Thomas S., Sandoval, Yader, Apple, Fred S., Newby, David E., Shah, Anoop S. V., and Mills, Nicholas L.

Published
2017
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23. Abstract 13566: High-Sensitivity Cardiac Troponin I at Presentation in Patients With Suspected Acute Coronary Syndrome

Author

Chapman, Andrew R, Lee, Kuan Ken, McAllister, David A, Cullen, Louise, Greenslade, Jaimi H, Parsonage, William, Worster, Andrew, Kavsak, Peter, Blankenberg, Stefan, Neumann, Johannes, Söerensen, Nils, Westermann, Dirk, Buijs, Madelon M, Verdel, Gerard J, Pickering, John W, Than, Martin P, Twerenbold, Raphael, Badertscher, Patrick, Sabti, Zaid, Mueller, Christian, Anand, Atul, Adamson, Philip, Strachan, Fiona E, Gray, Alasdair, Body, Richard, Keevil, Brian, Carlton, Edward, Greaves, Kim, Korley, Frederick K, Metkus, Thomas, Sandoval, Yader, Apple, Fred S, Newby, David, Shah, Anoop, and Mills, Nicholas L

Published
2017

24. Patient selection for high sensitivity cardiac troponin testing and diagnosis of myocardial infarction: prospective cohort study

Author

Shah, Anoop S V, Sandoval, Yader, Noaman, Ala, Sexter, Anne, Vaswani, Amar, Smith, Stephen W, Gibbins, Mathew, Griffiths, Megan, Chapman, Andrew R, Strachan, Fiona E, Anand, Atul, Denvir, Martin A, Adamson, Philip D, DʼSouza, Michelle S, Gray, Alasdair J, McAllister, David A, Newby, David E, Apple, Fred S, and Mills, Nicholas L

Published
2017
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26. 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

Author

Doudesis, Dimitrios, primary, Lee, Kuan Ken, additional, Yang, Jason, additional, Wereski, Ryan, additional, Shah, Anoop S V, additional, Tsanas, Athanasios, additional, Anand, Atul, additional, Pickering, John W, additional, Than, Martin P, additional, Mills, Nicholas L, additional, Strachan, Fiona E, additional, Tuck, Christopher, additional, Shah, Anoop SV, additional, Chapman, Andrew R, additional, Ferry, Amy V, additional, Doudesis, Dimitrios, additional, Bularga, Anda, additional, Taggart, Caelan, additional, Lowry, Matthew TH, additional, Mendusic, Filip, additional, Kimenai, Dorien M, additional, Sandeman, Dennis, additional, Adamson, Philip D, additional, Stables, Catherine L, additional, Vallejos, Catalina A, additional, Marshall, Lucy, additional, Stewart, Stacey D, additional, Fujisawa, Takeshi, additional, Hautvast, Mischa, additional, McPherson, Jean, additional, McKinlay, Lynn, additional, Ford, Ian, additional, Newby, David E, additional, Fox, Keith AA, additional, Berry, Colin, additional, Walker, Simon, additional, Weir, Christopher J, additional, Gray, Alasdair, additional, Collinson, Paul O, additional, Apple, Fred S, additional, Reid, Alan, additional, Cruikshank, Anne, additional, Findlay, Iain, additional, Amoils, Shannon, additional, McAllister, David A, additional, Maguire, Donogh, additional, Stevens, Jennifer, additional, Norrie, John, additional, Andrews, Jack PM, additional, Moss, Alastair, additional, Anwar, Mohamed S, additional, Hung, John, additional, Malo, Jonathan, additional, Fischbacher, Colin, additional, Croal, Bernard L, additional, Leslie, Stephen J, additional, Keerie, Catriona, additional, Parker, Richard A, additional, Walker, Allan, additional, Harkess, Ronnie, additional, Wackett, Tony, additional, Armstrong, Roma, additional, Stirling, Laura, additional, MacDonald, Claire, additional, Sadat, Imran, additional, Finlay, Frank, additional, Charles, Heather, additional, Linksted, Pamela, additional, Young, Stephen, additional, Alexander, Bill, additional, and Duncan, Chris, additional

Published
2022
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27. Coronary Artery and Cardiac Disease in Patients With Type 2 Myocardial Infarction: A Prospective Cohort Study

Author

Bularga, Anda, primary, Hung, John, additional, Daghem, Marwa, additional, Stewart, Stacey, additional, Taggart, Caelan, additional, Wereski, Ryan, additional, Singh, Trisha, additional, Meah, Mohammed N., additional, Fujisawa, Takeshi, additional, Ferry, Amy V., additional, Chiong, Justin, additional, Jenkins, William S., additional, Strachan, Fiona E., additional, Semple, Scott, additional, van Beek, Edwin J.R., additional, Williams, Michelle, additional, Dey, Damini, additional, Tuck, Chris, additional, Baker, Andrew H., additional, Newby, David E., additional, Dweck, Marc R., additional, Mills, Nicholas L., additional, and Chapman, Andrew R., additional

Published
2022
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28. Comparison of the Efficacy and Safety of Early Rule-Out Pathways for Acute Myocardial Infarction

Author

Chapman, Andrew R., Anand, Atul, Boeddinghaus, Jasper, Ferry, Amy V., Sandeman, Dennis, Adamson, Philip D., Andrews, Jack, Tan, Stephanie, Cheng, Sheun F., D’Souza, Michelle, Orme, Kate, Strachan, Fiona E., Nestelberger, Thomas, Twerenbold, Raphael, Badertscher, Patrick, Reichlin, Tobias, Gray, Alasdair, Shah, Anoop S.V., Mueller, Christian, Newby, David E., and Mills, Nicholas L.

Published
2017
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29. Implementation of an early rule-out pathway for myocardial infarction using a high-sensitivity cardiac troponin T assay

Author

Sandeman, Dennis, primary, Syed, Maaz B J, additional, Kimenai, Dorien M, additional, Lee, Kuan Ken, additional, Anand, Atul, additional, Joshi, Shruti S, additional, Dinnel, Lorraine, additional, Wenham, Philip R, additional, Campbell, Ken, additional, Jarvie, Mary, additional, Galloway, Donna, additional, Anderson, Mhairi, additional, Roy, Bappa, additional, Andrews, Jack P M, additional, Strachan, Fiona E, additional, Ferry, Amy V, additional, Chapman, Andrew R, additional, Elsby, Sarah, additional, Francis, Mark, additional, Cargill, Robert, additional, Shah, Anoop S V, additional, and Mills, Nicholas L, additional

Published
2021
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30. High-sensitivity cardiac troponin on presentation to rule out myocardial infarction: a stepped-wedge cluster randomized controlled trial

Author

Anand, Atul, Lee, Kuan Ken, Chapman, Andrew R., Ferry, Amy V., Adamson, Phil D., Strachan, Fiona E., Berry, Colin, Findlay, Iain, Cruikshank, Anne, Reid, Alan, Collinson, Paul O., Apple, Fred S., McAllister, David, Maguire, Donogh, Fox, Keith A.A., Newby, David E., Tuck, Chris, Harkess, Ronald, Keerie, Catriona, Weir, Christopher J., Parker, Richard A., Gray, Alasdair, Shah, Anoop S.V., and Mills, Nicholas

Abstract

Background: High-sensitivity cardiac troponin assays enable myocardial infarction to be ruled out earlier, but the safety and efficacy of this approach is uncertain. We investigated whether an early-rule out pathway is safe and effective for patients with suspected acute coronary syndrome.\ud \ud Methods: We performed a stepped-wedge cluster randomized controlled trial in the Emergency Departments of seven acute care hospitals in Scotland. Consecutive patients presenting with suspected acute coronary syndrome between December 2014 and December 2016 were included. Sites were randomized to implement an early rule-out pathway where myocardial infarction was excluded if high-sensitivity cardiac troponin I concentrations were

Published
2021

33. Monitoring indirect impact of COVID-19 pandemic on services for cardiovascular diseases in the UK

Author

Ball, Simon, Banerjee, Amitava, Berry, Colin, Boyle, Jonathan R, Bray, Benjamin, Bradlow, William, Chaudhry, Afzal, Crawley, Rikki, Danesh, John, Denniston, Alastair, Falter, Florian, Figueroa, Jonine D, Hall, Christopher, Hemingway, Harry, Jefferson, Emily, Johnson, Tom, King, Graham, Lee, Kuan Ken, McKean, Paul, Mason, Suzanne, Mills, Nicholas L, Pearson, Ewen, Pirmohamed, Munir, Poon, Michael TC, Priedon, Rouven, Shah, Anoop, Sofat, Reecha, Sterne, Jonathan AC, Strachan, Fiona E, Sudlow, Cathie LM, Szarka, Zsolt, Whiteley, William, Wyatt, Michael, CVD-COVID-UK Consortium, Banerjee, Amitava [0000-0001-8741-3411], Berry, Colin [0000-0002-4547-8636], Hemingway, Harry [0000-0003-2279-0624], Lee, Kuan Ken [0000-0003-3404-4098], Mills, Nicholas L [0000-0003-0533-7991], Poon, Michael TC [0000-0002-0053-2184], and Apollo - University of Cambridge Repository

Subjects
health care delivery, Health Services Needs and Demand, Time Factors, Delivery of Health Care, Integrated, COVID-19, heart disease, global health care delivery, United Kingdom, aortic and arterial disease, Cross-Sectional Studies, Patient Admission, Cardiovascular Diseases, Humans, epidemiology, Cardiology Service, Hospital, Emergency Service, Hospital, Needs Assessment, Retrospective Studies
Abstract

OBJECTIVE: To monitor hospital activity for presentation, diagnosis and treatment of cardiovascular diseases during the COVID-19) pandemic to inform on indirect effects. METHODS: Retrospective serial cross-sectional study in nine UK hospitals using hospital activity data from 28 October 2019 (pre-COVID-19) to 10 May 2020 (pre-easing of lockdown) and for the same weeks during 2018-2019. We analysed aggregate data for selected cardiovascular diseases before and during the epidemic. We produced an online visualisation tool to enable near real-time monitoring of trends. RESULTS: Across nine hospitals, total admissions and emergency department (ED) attendances decreased after lockdown (23 March 2020) by 57.9% (57.1%-58.6%) and 52.9% (52.2%-53.5%), respectively, compared with the previous year. Activity for cardiac, cerebrovascular and other vascular conditions started to decline 1-2 weeks before lockdown and fell by 31%-88% after lockdown, with the greatest reductions observed for coronary artery bypass grafts, carotid endarterectomy, aortic aneurysm repair and peripheral arterial disease procedures. Compared with before the first UK COVID-19 (31 January 2020), activity declined across diseases and specialties between the first case and lockdown (total ED attendances relative reduction (RR) 0.94, 0.93-0.95; total hospital admissions RR 0.96, 0.95-0.97) and after lockdown (attendances RR 0.63, 0.62-0.64; admissions RR 0.59, 0.57-0.60). There was limited recovery towards usual levels of some activities from mid-April 2020. CONCLUSIONS: Substantial reductions in total and cardiovascular activities are likely to contribute to a major burden of indirect effects of the pandemic, suggesting they should be monitored and mitigated urgently.

Published
2020
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36. Atrial fibrillation self-management: a mobile telephone app scoping review and content analysis

Author

Pearsons, Alice, primary, Hanson, Coral L, additional, Gallagher, Robyn, additional, O’Carroll, Ronan E, additional, Khonsari, Sahar, additional, Hanley, Janet, additional, Strachan, Fiona E, additional, Mills, Nicholas L, additional, Quinn, Terence J, additional, McKinstry, Brian, additional, McHale, Sheona, additional, Stewart, Stacey, additional, Zhang, Mengying, additional, O’Connor, Siobhan, additional, and Neubeck, Lis, additional

Published
2020
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39. High-sensitivity cardiac troponin on presentation to rule out myocardial infarction: a stepped-wedge cluster randomised controlled trial

Author

Anand, Atul, primary, Lee, Kuan Ken, additional, Chapman, Andrew R., additional, Ferry, Amy V., additional, Adamson, Phil D., additional, Strachan, Fiona E., additional, Berry, Colin, additional, Findlay, Iain, additional, Cruikshank, Anne, additional, Reid, Alan, additional, Collinson, Paul O., additional, Apple, Fred S., additional, McAllister, David A., additional, Maguire, Donogh, additional, Fox, Keith A.A., additional, Newby, David E., additional, Tuck, Chris, additional, Harkess, Ronald, additional, Keerie, Catriona, additional, Weir, Christopher J., additional, Parker, Richard A., additional, Gray, Alasdair, additional, Shah, Anoop S.V., additional, and Mills, Nicholas L., additional

Published
2020
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43. Exploring Patient Experience of Chest Pain Before and After Implementation of an Early Rule-Out Pathway for Myocardial Infarction: A Qualitative Study

Author

Ferry, Amy V., primary, Strachan, Fiona E., additional, Stewart, Stacey D., additional, Marshall, Lucy, additional, Lee, Kuan K., additional, Anand, Atul, additional, Shah, Anoop S.V., additional, Chapman, Andrew R., additional, Mills, Nicholas L., additional, and Cunningham-Burley, Sarah, additional

Published
2020
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45. Sex-Specific Thresholds of High-Sensitivity Troponin in Patients With Suspected Acute Coronary Syndrome

Author

Lee, Kuan Ken, primary, Ferry, Amy V., additional, Anand, Atul, additional, Strachan, Fiona E., additional, Chapman, Andrew R., additional, Kimenai, Dorien M., additional, Meex, Steven J.R., additional, Berry, Colin, additional, Findlay, Iain, additional, Reid, Alan, additional, Cruickshank, Anne, additional, Gray, Alasdair, additional, Collinson, Paul O., additional, Apple, Fred S., additional, McAllister, David A., additional, Maguire, Donogh, additional, Fox, Keith A.A., additional, Newby, David E., additional, Tuck, Chris, additional, Keerie, Catriona, additional, Weir, Christopher J., additional, Shah, Anoop S.V., additional, Mills, Nicholas L., additional, Tuck, Christopher, additional, Lee, Kuan Ken, additional, Sandeman, Dennis, additional, Adamson, Philip D., additional, Stables, Catherine L., additional, Vallejo, Catalina A., additional, Tsanasis, Athanasios, additional, Marshall, Lucy, additional, Stewart, Stacey D., additional, Fujisawa, Takeshi, additional, Hautvast, Mischa, additional, McPherson, Jean, additional, McKinlay, Lynn, additional, Walker, Simon, additional, Ford, Ian, additional, Cruikshank, Anne, additional, Amoils, Shannon, additional, Stevens, Jennifer, additional, Norrie, John, additional, Weir, Christopher, additional, Andrews, Jack P.M., additional, Moss, Alastair, additional, Anwar, Mohamed S., additional, Hung, John, additional, Malo, Jonathan, additional, Fischbacher, Colin M., additional, Croal, Bernard L., additional, Leslie, Stephen J., additional, Parker, Richard A., additional, Walker, Allan, additional, Harkess, Ronnie, additional, Wackett, Tony, additional, Armstrong, Roma, additional, Flood, Marion, additional, Stirling, Laura, additional, MacDonald, Claire, additional, Sadat, Imran, additional, Finlay, Frank, additional, Charles, Heather, additional, Linksted, Pamela, additional, Young, Stephen, additional, Alexander, Bill, additional, and Duncan, Chris, additional

Published
2019
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47. Performance of the GRACE 2.0 score in patients with type 1 and type 2 myocardial infarction.

Author

Hung, John, Roos, Andreas, Kadesjö, Erik, McAllister, David A, Kimenai, Dorien M, Shah, Anoop S V, Anand, Atul, Strachan, Fiona E, Fox, Keith A A, Mills, Nicholas L, Chapman, Andrew R, and Holzmann, Martin J

Subjects
ACUTE coronary syndrome, MYOCARDIAL infarction risk factors, MYOCARDIAL infarction complications, PUBLIC health
Abstract

Aims The Global Registry of Acute Coronary Events (GRACE) score was developed to evaluate risk in patients with myocardial infarction. However, its performance in type 2 myocardial infarction is uncertain. Methods and results In two cohorts of consecutive patients with suspected acute coronary syndrome from 10 hospitals in Scotland (n  = 48 282) and a tertiary care hospital in Sweden (n  = 22 589), we calculated the GRACE 2.0 score to estimate death at 1 year. Discrimination was evaluated by the area under the receiver operating curve (AUC), and compared for those with an adjudicated diagnosis of type 1 and type 2 myocardial infarction using DeLong's test. Type 1 myocardial infarction was diagnosed in 4981 (10%) and 1080 (5%) patients in Scotland and Sweden, respectively. At 1 year, 720 (15%) and 112 (10%) patients died with an AUC for the GRACE 2.0 score of 0.83 [95% confidence interval (CI) 0.82–0.85] and 0.85 (95% CI 0.81–0.89). Type 2 myocardial infarction occurred in 1121 (2%) and 247 (1%) patients in Scotland and Sweden, respectively, with 258 (23%) and 57 (23%) deaths at 1 year. The AUC was 0.73 (95% CI 0.70–0.77) and 0.73 (95% CI 0.66–0.81) in type 2 myocardial infarction, which was lower than for type 1 myocardial infarction in both cohorts (P  < 0.001 and P  = 0.008, respectively). Conclusion The GRACE 2.0 score provided good discrimination for all-cause death at 1 year in patients with type 1 myocardial infarction, and moderate discrimination for those with type 2 myocardial infarction. Trial registration ClinicalTrials.gov number, NCT01852123. [ABSTRACT FROM AUTHOR]

Published
2021
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