Nicholas Mills

PROPOSAL for a new clinical classification of acute myocardial infarction Published online today @NatureMedicine Open access link: rdcu.be/dkvtT #ESC2023 🧵[1/10]

The wonderful @CircAHA team presenting highlights from recent publications in the journal… and the Social Media work 😁 #ESCCongress2024 We now have ~75 000 followers on X and #CirculationOnTheRun podcast has > 1 mill downloads and 75000 🙌🏻

Announcing our @TheLancet commission on inequalities & disparities in cardiovascular health led by @RBugiardini , cochaired by me & @cpgale3 with our amazing WG @MaasAngela @DrSoniaAnand1 @PoojaJha2015 @OliviaManfrini et al @SmidtHeart @CedarsSinaiMed 📎rb.gy/5c1nh2

Don't forget to register for the 18th Annual Biomarkers Symposium! Abstract submission deadline EXTENDED to Monday, April 29- submit your abstracts and case reports, and see you on Friday, May 3! BiomarkersSymposium.com @UCSDHealth @UCSDCardiology @ucsdim

@DrMarkRoss Thanks for sharing this. Interesting study. The absolute differences were very small though (<1 ng/L) and not clear how loss to follow up might have impacted this endpoint, but encouraging none the less

Interesting findings @HighSTEACS : Structured exercise training reduces resting Hs-cTnI levels in HFrEF patients (only those w/o comorbidities) onlinelibrary.wiley.com/doi/10.1002/eh…

The @HighSTEACS lab is recruiting! looking for an enthusiastic & talented individual to join our #biomarker lab bit.ly/3tKlGEc @EdinUniCVS Job advert: rb.gy/m8umgw Closing date 1st April 2024 #jobs #laboratory #technician #biomedicalscientist Please Share!

Additive antithrombotic effects of PAR4 antagonism in patients with coronary artery disease receiving single or dual antiplatelet therapies @HighSTEACS @SamuelDebono @jennynashville ahajrnls.org/3Tg6LiZ

Really excited to share the results of the EPOCHS study, a collaborative multicentre observational study of cardiogenic shock in Scotland. Highlights: ➡️ CS = 3% of ICU admissions in 🏴󠁧󠁢󠁳󠁣󠁴󠁿 ➡️ Half due to acute MI, half other causes ➡️ 30-day mortality 54% journals.sagepub.com/eprint/INFTPFJ…

@J_Boeddinghaus @RIE_Lothian @RIECathLab @UniSpitalBasel @CRIBasel @chapdoc1 @RongBing5 @HenriksenDr @andabularga @CaelanTaggart @RyanWereski @MartinDenvir @TzolosEvangelos @KuanKenLee @UniSpitalBasel have a superb interventional cardiologist, researcher and colleague coming! Thank you for joining us in Edinburgh and for your brilliant contribution ⭐️

@cpgale3 Primary outcome modified during conduct as event rate for MACE so low. This was due to exclusion of MI patients with diabetes, heart failure and renal disease where drug already indicated.

Canvassing thoughts about the DAPA-MI trial; specifically the reduction of cardiometabolic endpoints with #Dapagliflozin post #heartattack

#Scotland the best place to train in Cardiology again

Latest @NatureComms paper from Long-Covid In Scotland Study. Following adjustment for potential confounders, the attributable prevalence of ongoing symptoms at 6, 12, and 18 months post-infection is 6.6%, 6.5%, and 10.4% respectively #LongCovid #COVID19 nature.com/articles/s4146…

A high sensitivity cardiac troponin I assay in the assessment of patients with suspected acute coronary syndrome was associated with a reduced risk of subsequent myocardial infarction or death in those reclassified by the assay, finds study bmj.com/content/383/bm…

Perhaps detecting all those non-ACS troponin elevations is benefitting our patients after all...? 5-year outcomes of the HighSTEACS trial published today in @bmj_latest bmj.com/content/383/bm… @HighSTEACS @DDoudesis @BHFScotland @dataloch 1/n

@jdrwilcox Josh, I think you are right. Need to work out how to help this group of patients

Fascinating results. Non ischaemic myocardial injury patients had most to gain from implementation of a high sensitivity troponin assay. We often feel like these people are caught in a crossfire, but perhaps they should be our targets…?!

@DrToddLee All cause mortality was an absolute 10% lower at 5 years in patients reclassified by high- sensitivity troponin. Not sure this matter to an immortal time lord though? @DrToddLee

@HighSTEACS But there was no difference in all cause mortality. So wasn't a lot of the difference due to what bin positive troponin subsequently gets put into (type 1 vs 2 vs non cardiac)?

Implementation of a high sensitivity cardiac troponin I assay and risk of myocardial infarction or death at five years: observational analysis of a stepped wedge, cluster randomised controlled trial bmj.com/content/383/bm…

@cpgale3 @bmj_latest Indeed in those without other high risk symptoms or signs an abnormal blood test is more likely to change the patient's course. We need evidence-based care pathways here.

@HighSTEACS 🤔, hs troponin is a marker of other modifiable prognostic disease states when presenting as suspected ACS. @bmj_latest

@DavidLBrownMD David I am an international cardiologist in the NHS in Scotland. I treat patients based on the evidence available and their preference. There is a role for PCI in stable angina, but for many medical therapy is sufficient. There is no less-is-more, there is just good care.

@HighSTEACS The bias was focused on ORBITA1. That was my point.

Does anybody else find it amusing that there are zero complaints about ORBITA 2 being too small or with too much single vessel disease or with too short a follow-up like there were with ORBITA1? What could be the difference?

@DavidLBrownMD Not a quantum leap, but a well conducted double-blind, sham controlled trial that demonstrates PCI is effective. Where is the bias?

@HighSTEACS 6 weeks vs. 12 weeks, 80% single vessel disease, an endpoint that has never been used before or valudated, confirmed pre-existing biases. Truly a quantum leap.