Can a new test for heart attack save lives?

High-Sensitive Troponin in the Evaluation of patients with Acute Coronary Syndrome (High-STEACS):
A randomised controlled trial

Nicholas Mills (lead researcher)

Edinburgh, University of

Start date: 01 October 2012 (Duration 3 years + 2 years)

Every year thousands of people in the UK are diagnosed as having had a heart attack. It is not always easy to confirm a heart attack has occurred, because the nature and severity of symptoms varies. One of the tests doctors use analyses blood levels of a molecule called troponin, which is produced by the heart when it is damaged. Using standard test kits, if the troponin level is greater than 200 nanograms (ng) per litre (L) of blood, a heart attack is diagnosed and a patient is given urgent treatment.

Pioneering work from Dr Nick Mills at the University of Edinburgh, together with BHF Professor David Newby, has shown that a new high-sensitive troponin test is more effective than the standard test. In a recent BHF-funded trial of more than 2,000 patients at NHS Lothian Hospital in Edinburgh, Dr Mills’ team showed that using a lower diagnostic threshold of 50ng/L, the high-sensitivity test diagnosed 29 per cent more heart attacks than the standard test. Some patients with troponin levels of between 50ng/and 200ng/L were prioritised for treatment. In these patients, the numbers of deaths and recurring heart attacks more than halved compared with those who were treated as not having had a heart attack.

But the new test could still be improved. To reach a standard recommended by some official guidelines, Dr Mills’ team needs to be able to detect troponin levels right down to just 16ng/L. This award will enable Dr Mills’ team to carry out a trial of another, ultra-sensitive troponin test in approximately 15,000 patients with suspected heart attacks across Scotland, comparing its effectiveness with their high-sensitivity test.

An important consideration is that people at the lower end of the troponin spectrum – between 16-50ng/L – may have troponin in their blood for other reasons, such as infection or kidney failure. There is a risk that lowering the threshold could misdiagnose heart attacks and give people unnecessary and potentially harmful treatments. Clarifying what is best for these patients is a crucial part of this study. If successful, this study could lead to a more accurate, new heart attack test that could be used widely in clinical practice.

Project details

Grant amount £702,166
Grant type Special Project
Start Date 01 October 2012
Duration 3 years + 2 years
Reference SP/12/10/29922
Status Complete

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