Early detection of obstructive coronary artery disease in the asymptomatic high-risk population: objectives and study design of the EARLY-SYNERGY trial

Daan Ties*, Paulien van Dorp, Gabija Pundziute, Carlijn M. van der Aalst, Jan Willem C. Gratama, Richard L. Braam, Dirkjan Kuijpers, Daniël D. Lubbers, Ivo A.C. van der Bilt, B. Daan Westenbrink, Martijn J.Oude Wolcherink, Carine J.M. Doggen, Ivana Išgum, Robin Nijveldt, Harry J. de Koning, Rozemarijn Vliegenthart, Matthijs Oudkerk, Pim van der Harst

*Corresponding author for this work

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Abstract

Background: Coronary artery disease (CAD) burden for society is expected to steeply increase over the next decade. Improved feasibility and efficiency of preventive strategies is necessary to flatten the curve. Acute myocardial infarction (AMI) is the main determinant of CAD-related mortality and morbidity, and predominantly occurs in individuals with more advanced stages of CAD causing subclinical myocardial ischemia (obstructive CAD; OCAD). Unfortunately, OCAD can remain subclinical until its destructive presentation with AMI or sudden death. Current primary preventive strategies are not designed to differentiate between non-OCAD and OCAD and the opportunity is missed to treat individuals with OCAD more aggressively. Methods: EARLY-SYNERGY is a multicenter, randomized-controlled clinical trial in individuals with coronary artery calcium (CAC) presence to study (1.) the yield of cardiac magnetic resonance stress myocardial perfusion imaging (CMR-MPI) for early OCAD diagnosis and (2) whether early OCAD diagnosis improves outcomes. Individuals with CAC score ≥300 objectified in 2 population-based trials (ROBINSCA; ImaLife) are recruited for study participation. Eligible candidates are randomized 1:1 to cardiac magnetic resonance stress myocardial perfusion imaging (CMR-MPI) or no additional functional imaging. In the CMR-MPI arm, feedback on imaging results is provided to primary care provider and participant in case of guideline-based actionable findings. Participants are followed-up for clinical events, healthcare utilization and quality of life. Conclusions: EARLY-SYNERGY is the first randomized-controlled clinical trial designed to test the hypothesis that subclinical OCAD is widely present in the general at-risk population and that early differentiation of OCAD from non-OCAD followed by guideline-recommended treatment improves outcomes.

Original languageEnglish
Pages (from-to)166-177
Number of pages12
JournalAmerican Heart Journal
Volume246
DOIs
Publication statusPublished - Apr 2022

Bibliographical note

Acknowledgements:
This research was supported by the Dutch Heart Foundation (EARLY-SYNERGY – research grant CVON2015-17) and Siemens Healthineers (PUSH – partnership IPA No.11 PUSH MRA). The Lifelines Biobank initiative has been made possible by funding by FES (Fonds Economische Structuurversterking), SNN (Samenwerkingsverband Noord Nederland) and REP (Ruimtelijk Economisch Programma). The ImaLife study is supported by an institutional research grant from Siemens Healthineers and by the Ministry of Economic Affairs and Climate Policy by means of the PPP Allowance made available by the Top Sector Life Sciences & Health to stimulate public-private partnerships. The ROBINSCA trial has been made possible by funding by the EU (ROBINSCA – Advanced research grant: grantnumber 294604). The authors wish to acknowledge the services of the Lifelines Cohort Study, the contributing research centers delivering data to Lifelines, and all the study participants. The authors are grateful to all the imaging technicians and supporting personnel at the local hospitals for their contribution to conducting the study.

Publisher Copyright: © 2022 The Authors

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