Myocardial Infarction in the Young: A Prospective Clinical Registry Study

This is an investigator-initiated, observational, single-centre clinical registry study of young patients with Myocardial Infarction (MI). Patients will be recruited at Westmead hospital post MI, after they are considered to be in stable condition or pre-discharge. Eligible patients at Westmead Hospital will be identified and recruited into the study prospectively by the research team. Prospective patients will be recruited upon admission with a diagnosis of myocardial infarction. Follow up will be performed at 30 days, 1 year and yearly thereafter for up to 4 years. Questionnaires will be sent directly to participants and will take ~5-7min to complete each questionnaire. The questionnaire are to collect their pre- and post-myocardial infarction family and medical history, exercise, stress, quality of life and medication use data. As this is an observational study, all data will be collected either from participants medical records or questionnaires. No additional tests and cardiac scans for this study purpose will be required. Participants will sign their informed consent for their medical records to be accessed/collected, as well as centralised data collection, and for ongoing yearly follow up for 4 years, with the ability to opt-out at any stage. They will also be asked regarding their willingness to be contacted about future clinical trials. This study will be completely observational in nature, and no intervention will be performed. If patients only consent for the observational study but not the blood collection, consenting may be performed via a telephone consultation if required by a research nurse or study coordinator. Participants will be mailed or emailed the participant information and consent form for reading. After a few days they will be re-contacted to obtain/record their consent. Face-to-face consenting will be used for all patients who wish to consent for blood collection. If participant provides additional consent to collect blood for additional genomics and proteomics analysis, a one-off 40mL blood sample ( at baseline) will be taken via an intravenous cannula, or by venepuncture if a cannula is not available. The blood will be collected in EDTA, serum and citrate tubes. The samples will be stored at -80oC in locked and alarmed freezers at the Westmead Institute of Medical Research (WIMR). Blood samples will be tested for cell adhesion and inflammation markers such as VCAM-1, ICAM-1 and IL-6. NETs markers in samples will be analysed using immunochemistry staining and ELISA. Flow cytometry will also be performed. Patients will be recruited with their baseline clinical data entered locally by a study coordinator, into an online centralised database. Baseline data includes background medical history, cardiovascular risk factors (traditional e.g., smoking, diabetes, family history / non-traditional e.g., pre-eclampsia, chronic inflammatory conditions, premature menopause), examination at baseline (e.g. weight, height, body mass index), medications at baseline and on discharge, presentation, triggers, investigations (including multimodality imaging, coronary angiography, echocardiogram), management (including revascularisation) and in-hospital outcomes. Available in-hospital pathology results that have already been performed as part of standard care, including serum creatinine and electrolytes, liver function, full blood count, high sensitivity C-reactive protein (hs-CRP), fasting lipids and lipid biomarkers (e.g. TC, LDL, HDL, triglycerides) and diabetic profiles, will be collected. The follow-up will be largely electronic by participants receiving an email link to a secure survey generated by the REDCap database that assesses self-reported outcomes. Telephone contact will be performed when required by each site if participants are unable to complete the survey. This will be with the use of telephone interpreters as needed for those of Non-English speaking backgrounds, and hospital/medical records obtained to clarify diagnoses, as required. Thirty day follow up will include a Quality of Life (QoL) assessment using the EQ-5D questionnaire. Clinical outcomes will be total and cardiac mortality, myocardial infarction recurrence, major adverse cardiovascular events (MACE) and major adverse cardiac and cerebrovascular events (MACCE).