NCT03338504: DEMAND-MI

Determining the Mechanism of Myocardial Injury and Role of Coronary Disease in Type 2 Myocardial Infarction

Completed Last updated 10 June 2022

What this trial tests

trial testing Invasive coronary angiography in Myocardial Infarction, Acute in 100 participants. Completed in 6 November 2021.

Timeline

23 October 2017

Primary endpoint
6 November 2020

6 November 2021

Quick facts

Lead sponsor	University of Edinburgh
Status	Completed
Study type	OBSERVATIONAL
Enrollment	100
Start date	23 October 2017
Primary completion	6 November 2020
Estimated completion	6 November 2021
Sites	1 location across United Kingdom

Drugs / interventions tested

• Invasive coronary angiography
• CT coronary angiography
• Cardiac MRI

Conditions studied

• Myocardial Infarction, Acute — all drugs for Myocardial Infarction, Acute →
• Myocardial Ischemia — all drugs for Myocardial Ischemia →
• Myocardial Injury — all drugs for Myocardial Injury →

Sponsor

University of Edinburgh

Who can join

Eligibility, any sex, with Myocardial Infarction, Acute or Myocardial Ischemia. Patients with the condition only — healthy volunteers not accepted.

Sponsor's own description

Myocardial injury is common in patients without acute coronary syndrome, and therefore international guidelines propose a classification of patients with myocardial infarction by aetiology. This differentiates between myocardial infarction due to plaque rupture (type 1) and myocardial oxygen supply-demand imbalance (type 2) in other acute illnesses. However, these guidelines have not been widely adopted as the diagnostic criteria for type 2 myocardial infarction are not clearly defined. Patients with type 2 myocardial infarction have poor long term outcomes, with at least twice the mortality at five years compared to those with an index type 1 myocardial infarction. Despite the majority of deaths being attributable to non-cardiovascular events, the rate of future type 1 myocardial infarction or cardiovascular death is similar regardless of index classification. If this future risk is related to the presence of underlying coronary artery disease, then there may be the potential to improve outcomes through targeted investigation and secondary prevention. The investigators will undertake a systematic evaluation of the mechanism of myocardial injury and the role of coronary artery disease in 100 patients with elevated cardiac troponin concentrations where the diagnosis is likely to be type 2 myocardial infarction. These studies will help improve the assessment of patients with myocardial injury, refine the diagnostic criteria for type 2 myocardial infarction, and aid the design of future therapeutic trials.

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

1. Assessment and Treatment of Patients With Type 2 Myocardial Infarction and Acute Nonischemic Myocardial Injury.
   DeFilippis AP, Chapman AR, Mills NL, de Lemos JA, et al · · 2019 · cited 260× · PMID 31416350 · DOI 10.1161/circulationaha.119.040631
2. Cardiovascular Mortality After Type 1 and Type 2 Myocardial Infarction in Young Adults.
   Singh A, Gupta A, DeFilippis EM, Qamar A, et al · · 2020 · cited 60× · PMID 32138959 · DOI 10.1016/j.jacc.2019.12.052
3. Coronary Artery and Cardiac Disease in Patients With Type 2 Myocardial Infarction: A Prospective Cohort Study.
   Bularga A, Hung J, Daghem M, Stewart S, et al · · 2022 · cited 50× · PMID 35341327 · DOI 10.1161/circulationaha.121.058542
4. Type 2 Myocardial Infarction: Evolving Approaches to Diagnosis and Risk-Stratification.
   Chapman AR, Sandoval Y. · · 2021 · cited 21× · PMID 33418588 · DOI 10.1093/clinchem/hvaa189
5. Type 2 myocardial infarction: a diagnostic and therapeutic challenge in contemporary cardiology.
   Merlo AC, Bona RD, Ameri P, Porto I. · · 2022 · cited 10× · PMID 35157215 · DOI 10.1007/s11739-021-02920-8
6. Implications of a new clinical classification of acute myocardial infarction.
   Boeddinghaus J, Bularga A, Taggart C, Wereski R, et al · · 2025 · cited 6× · PMID 39824208 · DOI 10.1093/ehjacc/zuaf002
7. Distinguishing Type 1 from Type 2 Myocardial Infarction by Using CT Coronary Angiography.
   Meah MN, Bularga A, Tzolos E, Chapman AR, et al · · 2022 · cited 6× · PMID 36339063 · DOI 10.1148/ryct.220081
8. The Intersection of Type 2 Myocardial Infarction and Heart Failure.
   McCarthy CP, Jones-O'Connor M, Olshan DS, Murphy S, et al · · 2021 · cited 6× · PMID 34423653 · DOI 10.1161/jaha.121.020849