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Benefit to patients and the NHS of cardiac magnetic resonance imaging (CMR) after Primary percutaneous coronary Intervention (PPCI) Pathway Activation.

Dates: 2013 - 2014
Funding: NIHR Health Services Research programme
Principal Investigators: Dr Chiara Bucciarelli-Ducci and Prof Barney Reeves, University of Bristol
Information: Sarah Wordsworth, Liz Stokes

Patients who have had a heart attack are usually referred for PPCI, an emergency procedure in which the blocked artery that stopped blood flow to the heart is opened up and kept open using a metal stent (tube).  Patients who activate the PPCI pathway normally have echocardiography (ECHO) following the procedure, a non-invasive test of heart function.  Doctors are increasingly using another non-invasive test, CMR, to assess damage to the heart, which is believed to measure heart function more precisely than ECHO.  The information from CMR may help doctors to manage these patients more appropriately; however it is not currently known whether having CMR reduces the risk of adverse outcomes.

This prospective multi-centre feasibility cohort study will be set up to document CMR use in patients activating the PPCI pathway to determine whether this test can be used to improve outcomes.  Four PPCI centres (two with and two without CMR) will be recruited and clinical outcomes and medical management compared among those who have and have not had CMR.  Given the uncertainty about the number of patients who have CMR, and the challenges of linking stored electronic patient data from multiple hospitals and defining changes in patient management prompted by information from CMR, this feasibility study will help to determine whether setting up a registry is feasible and worthwhile for the NHS.

The health economic component of the study aims to evaluate whether using CMR after PPCI pathway activation represents good value for money for the NHS.  The feasibility study will allow us to determine whether sufficient economic data can be obtained for a CMR registry, and to identify key model parameters for focussed measurement.  For the feasibility study we will undertake two main tasks.  Firstly, the feasibility of gathering data required to facilitate a cost-effectiveness analysis (e.g. resource use, costs, outcomes) will be examined to inform the data requirements of a full CMR registry.  Secondly, the use of these data within a cost-effectiveness model will be explored to identify parameters with the potential to be key drivers of cost-effectiveness, and hence requiring detailed measurement in the CMR registry.