Improving cardiovascular outcomes in acute coronary syndrome

A joint study with industry which supports better identification of high risk patients

Collaborating with industry on the ICON1 study

Lead researcher: Dr Vijay Kunadian

Coronary artery disease is the most common cause of death in the United Kingdom for people over the age of 65. Almost half of all heart attacks occur in those over the age of 70 years. Older patients, particularly those that are frail, who present with acute coronary syndrome (heart attack or unstable angina), have poorer outcomes compared to their younger counterparts. Despite this, there is very little research data available on older patients with acute coronary syndrome; over half of all trials between 1996 and 2000 did not enrol patients over the age of 75 years, and over a third actively excluded them. ICON1 is an observational study that has been designed to investigate patients over the age of 75, who are at a higher risk following an acute coronary syndrome, by performing a comprehensive evaluation of their cardiovascular disease burden.

The study was funded by the NIHR Newcastle Biomedical Research Centre and established links with Volcano Corporation who are at the forefront of research in coronary intravascular imaging.  We have also worked closely with ITAMAR Medical who has provided consumables to measure arterial function. Dr. Weiliang Qiu, Associate Professor in Biostatistics, Harvard Medical School, USA provided support with advanced statistics and risk model development.

The need for research

Before this research took place, it wasn’t easy to identify the likelihood of each patient experiencing further problems after stenting for acute coronary syndrome. The ability to predict who will experience future problems can be helpful in providing additional treatment and close monitoring to those that are at risk.

The results therefore, can be used to develop a risk score that provides physicians with valuable information on each patient. This can provide a better understanding of how to manage older patients with coronary artery disease. It can also help to plan future studies evaluating treatment strategies that might be beneficial in improving outcomes in neglected high risk older patients.

For the public, ICON1 will help to explain why frail older people have poor outcomes following a heart attack, and help individualise treatment based on the underlying coronary artery pathology in the future. For the NHS and healthcare, it may predict which patients are at higher risk of poor outcomes following balloon and stent treatment, helping to target resources towards these individuals.