Active clinical trials for "Myocardial Infarction"

Large randomised trials have shown that cardiovascular medications prescribed to patients at high cardiovascular risk are effective in reducing the incidence of cardiovascular events. Their use is recommended in the United Kingdom and international guidelines (e.g. the National Institute of Clinical Excellence). However, these medications do not prevent cardiovascular events in all patients and there is now a body of research investigating the effects of cardiovascular medications on outcomes in myocardial infarction (MI), including clinical presentation, infarct size and post-MI mortality. However, the independent effects of cardiovascular drugs on post-MI all cause mortality are unclear, and there are limitations to many of the published studies in terms of their cardiovascular drug exposure data. This project utilizes prospectively collected data on cardiovascular drug use, and links to MI data from hospital and mortality records.

We designed this study to evaluate the effect of N-acetylcystein on biomarkers of platelet activation , cardiac necrosis and coronary reperfusion in patients undergoing percutaneous coronary intervention.

Cardiac rehabilitation is an individual adapted multidisciplinary intervention for people suffering from Heart Disease. It involves; Dietary counseling, Exercise training, Psychosocial support, Physician smoking cessation Patient education The purpose is quick and complete recovery and to reduce the chance of recurrence. In Denmark people admitted with Acute Cardiac Disease is referred to a course of hospital based cardiac rehabilitation at discharge. The Danish Municipal Reform of 2007 changed the responsibility of rehabilitation from the Regions, who runs the hospitals, to the municipalities. Shared care is in this setting that elements of treatment are completed different places in Health Care. The aim of this study is: to establish a shared care model for Cardiac rehabilitation following admission with Acute Coronary Syndrome and to compare this model to the existing hospital based cardiac rehabilitation after admission with Acute Coronary Syndrome. Primary outcome is participation in cardiac rehabilitation.

The purpose of this study is to determine the feasibility of pharmacogenomics testing in a community pharmacy using clopidogrel as an example. The investigators hypothesize that this testing is feasible in this setting.

Patients who developed an acute coronary syndrome despite dual antiplatelet therapy with aspirin and clopidogrel may benefit from a further dose of clopidogrel before a percutaneous coronary intervention. The aim of this study is to evaluate safety and effectiveness of clopidogrel reloading in patients on chronic clopidogrel therapy with acute coronary syndrome undergoing percutaneous coronary intervention.

This is an open-label PET/CT (positron emission tomography/computed tomography) study to investigate the diagnostic performance of 68Ga-BNOTA-PRGD2 in evaluation of myocardial infarction. A single dose of nearly 111 MBq 68Ga-BNOTA-PRGD2 ( ≤ 40 µg BNOTA-PRGD2) will be intravenously injected into myocardial infarction patients. Visual and semiquantitative method will be used to assess the 68Ga-BNOTA-PRGD2 PET/CT cardiac images and compared to the 99mTc-MIBI SPECT myocardial perfusion images and the 18F-FDG metabolism images.

Background to main study question: Cardiac complications are a common cause of morbidity after non-cardiac surgery. Patients with perioperative myocardial injury (both MI, and lower levels of cardiac troponin elevation) experience higher short-term and long-term mortality. They are also at substantially increased risk of additional cardiac and non-cardiac complications. It is therefore plausible that myocardial injury adversely affects quality of life. This study will compare postoperative health-related quality of life of patients who did or did not experience perioperative myocardial injury (defined by troponin-I > 0.07ng/ml) after non-cardiac surgery Study Design: Pilot prospective cohort study (n = 300). Population: Consecutive patients undergoing non-cardiac, non-transplant surgery at UHN. Background to secondary study questions: Clinically based risk stratification tools used in non-cardiac surgery (e.g., Revised Cardiac Risk Index) are of moderate utility and assign patients only to broad risk categories. This study will examine the usefulness of pre-operative biomarkers (BNP, HbA1c, and others) in supporting cardiac risk stratification and will address the question: Is there a set of preoperative criteria that can accurately inform the decision to monitor troponin postoperatively? Intra-operative physiological derangement measured with the Surgical Apgar Score correlates with morbidity and mortality 3-months postoperatively. This study will examine the relationship between the Surgical Apgar Score; continuous non-invasively monitored intraoperative metrics of hemoglobin concentration and occult hypovolemia (Pleth Variability Index) with the Masimo Radical-7 Pulse Co-Oximeter; and the primary and secondary outcomes. This aspect of the study will address the question: Can readily available intraoperative physiological data inform the decision to monitor troponin postoperatively? Quality of Recovery-40 Score evaluates (in the recovery room and at 24 hours postoperatively) the patient's subjective experience of their recovery from surgery. This metric is correlated with quality of life 3-months postop. This study will evaluate correlation between Quality of Recovery-15 Score, a valid and more efficient means of measuring recovery, and the primary and secondary outcomes. Approximately 2/3 of patients who have postoperative myocardial injury are asymptomatic and have no ECG changes. Diagnosis of MI requires biomarker elevation (Troponin > 0.3ng/ml) plus clinical or ECG or imaging evidence of myocardial injury. Of the latter 3 criteria, 2 are often absent. In selected patients, this study will use trans-thoracic echocardiography, CT coronary angiography, and cardiac MRI to improve diagnostic yield and define those diagnostic modalities that are most useful in the postoperative patient. Rationale: Postoperative myocardial injury may negatively impact health-related quality of life. Affected patients may experience higher levels of postoperative dependency. This possibility has implications for patient rehabilitation, provincial and personal healthcare costs, as well as patients' physical, emotional and mental well-being and relationships. The public health dimension of this problem could therefore be significant. In addition, an incomplete understanding exists of how individual patient cardiac risk factors, in combination with the perioperative environment, result in myocardial injury. The diagnostic investigations that are most useful in this setting have not yet been clearly defined. Patients who fail to be rescued after experiencing postoperative complications (as distinct from failure to avoid experiencing the complication in the first instance) plays a central role in postoperative mortality. Early recognition of such patients is therefore crucial. By prospectively observing a cohort of high-risk surgical patients, this study will provide insight into how these factors interact. This will allow us to better characterize the potential predictors and features of postoperative myocardial injury. We hope that our findings will aid in the identification of patient characteristics associated with increased risks of postoperative myocardial injury, thus helping to direct diagnosis, early treatment and rescue. This study will thus potentially yield important data that will positively impact future patient care and the rational use of healthcare resources.

The purpose of this registry is to determine if delivery of weight adjusted, in a large dose with either Abcixmab or Eptifibitide through the ClearWay™ RX, in patients admitted for primary coronary intervention lowers readmission rate. This is done in comparison to the historical control of the Medicare/Medicaid readmission database. The registry will record the use of the product during the index procedure, and determine whether or not the patient was readmitted within 30 days, related to the index procedure.

Contrast-induced nephropathy (CIN) represents a potential complication of diagnostic and therapeutic procedures in interventional cardiology, especially in the acute setting of primary PCI. The investigators will test the efficacy of sodium bicarbonate (NaHCO3) and N-acetylcysteine (NAC) on the prevention of acute events and CIN in patients with acute myocardial infarction.

This study evaluates the usefulness of noninvasive tests of the structure of the heart and the nervous system controlling the heart. It will assess whether combining tests that evaluate heart structure with others that measure the nervous system controlling the heart will identify most patients who develop serious heart rhythm problems after a heart attack.