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. 2025 May;4(5):101738.
doi: 10.1016/j.jacadv.2025.101738. Epub 2025 Apr 4.

Targeting Investigation and Treatment in Type 2 Myocardial Infarction: A Pilot Randomized Controlled Trial

Caelan Taggart  1 , Amy Ferry  1 , Stephanie Barker  1 , Kelly Williams  1 , Grace Souter  1 , Anda Bularga  1 , Ryan Wereski  1 , Michael J McDermott  1 , Michelle C Williams  1 , Jasper Boeddinghaus  2 , Christopher White  3 , Jagdeep S Singh  4 , Keith Boath  4 , Takeshi Fujisawa  1 , Christopher Tuck  1 , Anny Briola  1 , Steff Lewis  1 , Atul Anand  5 , Marc R Dweck  1 , David E Newby  1 , Rustam Al-Shahi Salman  6 , Nicholas L Mills  5 , Andrew R Chapman  7
Affiliations

Targeting Investigation and Treatment in Type 2 Myocardial Infarction: A Pilot Randomized Controlled Trial

Caelan Taggart et al. JACC Adv. 2025 May.

Abstract

Background: Type 2 myocardial infarction occurs in the absence of atherothrombosis, due to myocardial oxygen supply or demand imbalance, often during another acute illness. It is common and associated with poor clinical outcomes. No randomized controlled trials are available to guide investigation or treatment.

Objectives: The authors assessed the feasibility of implementing a complex intervention of investigation and treatment for coronary and structural heart disease in patients with type 2 myocardial infarction.

Methods: A pilot phase of a prospective randomized controlled trial was conducted. Process outcomes included the proportion of eligible patients approached, consented, and randomized. Adherence was defined as the number of recommended investigations and treatments administered at 90 days. Qualitative interviews explored reasons for participation and patient experience.

Results: Between November 2022 and November 2023, 4,127 patients with increased cardiac troponin concentrations were screened across 3 sites, and 403 patients (10%) met inclusion criteria. One hundred and forty-three patients (35%) were eligible, 119 patients (83%) were approached, and 60 patients (42%, age 70 ± 10 years, 38% women) consented and randomized to the intervention (n = 28) or standard care (n = 32). Follow-up was complete in all participants. Adherence to recommendations was 90.7% (95% CI: 85.3%-96.1%). Patients highlighted variation in communication of the diagnosis and in trial investigation and management recommendations were potential barriers to participation.

Conclusions: It is feasible to recruit and randomize patients with type 2 myocardial infarction to a complex intervention targeting coronary or structural heart disease. A multicenter trial with an optimized intervention is now required to inform practice.

Keywords: coronary angiography; echocardiography; secondary prevention; type 2 myocardial infarction; universal definition.

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Conflict of interest statement

Funding support and author disclosures This work was supported by Chief Scientist Office (Scotland) TCS 22/31. Dr Taggart is supported by a Clinical Research Training Fellowship (FS/CRTF/21/2473) from the British Heart Foundation. Dr Boeddinghaus is supported by an Edinburgh Doctoral College Scholarship and research grants from the University of Basel, the University Hospital of Basel, the Division of Internal Medicine, the Swiss Academy of Medical Sciences, the Gottfried and Julia Bangerter-Rhyner Foundation, and the Swiss National Science Foundation. Drs Bularga and Wereski are supported by Clinical Research Training Fellowships (MR/V007254/1 and MR/V007017/1, respectively) from the Medical Research Council. Dr Williams is supported by the British Heart Foundation (FS/ICRF/20/26002). Dr Newby is supported by the British Heart Foundation (CH/09/002, RG/F/22/110093, and RE/18/5/34216) and was the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). Dr Dweck is the recipient of the Sir Jules Thorn Award for Biomedical Science (15/JTA). Dr Mills is supported by a Chair Award (CH/F/21/90010), Programme Grant (RG/20/10/34966), and a Research Excellent Award (RE/24/130012) from the British Heart Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Central Illustration
Central Illustration
TARGET-Type 2: A Pilot Randomized Controlled Trial TARGET-type 2 was a pilot randomized controlled trial demonstrating it is feasible to recruit and randomize patients with type 2 myocardial infarction to a complex intervention targeting underlying coronary or structural heart disease. A main phase trial with an optimized intervention is now required to inform clinical practice. Abbreviations as in Figure 1.
Figure 1
Figure 1
Trial Flow Diagram According to CONSORT Guidelines CAS = coronary artery spasm; CONSORT = Consolidated Standards of Reporting Trials; eGFR = estimated glomerular filtration rate; MI = myocardial infarction; SCAD = spontaneous coronary artery dissection; T2MI = type 2 myocardial infarction.
Figure 2
Figure 2
A Comparison of Medications Received at 90 Days Post Randomization in the Control and the Intervention Arm The dark shaded area represents the proportion of medications which were prescribed to patients at the time of randomization, with the red shaded area indicating the proportion of additional new medications prescribed at 90 days. ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; DOAC = direct oral anticoagulant; SGLT2 = sodium-glucose cotransporter 2.
See this image and copyright information in PMC

References

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