What this study adds
ARC, Norrie, non-ischaemic myocardial injury, Competing, DMK, Ziwen Li, deaths
MYOCARDIAL INFARCTION, FRANK, FOX, EMERGENCY, HEART, SUBSEQUENT MYOCARDIAL INFARCTION
Implementation of a high sensitivity cardiac troponin assay with sex specific 99th centile thresholds resulted in fewer subsequent myocardial infarctions or deaths at five years in patients reclassified by the high sensitivity assayThe improvement in outcomes was greater in patients with an index diagnosis of non-ischaemic myocardial injury compared to those with type 1 or type 2 myocardial infarctionWe thank researchers from the Emergency Medicine Research Group Edinburgh and the British Heart Foundation Cardiovascular Biomarker Laboratory at the University of Edinburgh for their support during the conduct of the trial.The High-STEACS Investigators are: Chief investigator: Nicholas L Mills. Trial managers: Fiona E Strachan and Christopher Tuck. Trial research team: Atul Anand, Stephanie Barker, Jennifer Blades, Jasper Boeddinghaus, Anda Bularga, Andrew R Chapman, Dimitrios Doudesis, Amy V Ferry, Takeshi Fujisawa, Konstantin Georgiev, Jeremy Leung, Ziwen Li, Dorien M Kimenai, Kuan Ken Lee, Matthew TH Lowry, Lynn McKinlay, Michael McDermott, Jean McPherson, Filip Mendusic, Nicholas L Mills, Anoop SV Shah, Andrew Sorbie, Grace Souter, Stacey D Schulberg, Caelan Taggart, Christopher Tuck, Daniel Perez Vicencio, Yiqing Wang, Ryan Wereski, and Kelly Williams. Grant applicants: Nicholas L Mills (principal applicant), David E Newby, Keith A A Fox, Colin Berry, Simon Walker, and Christopher J Weir. Trial steering committee: Ian Ford (chair, independent), Nicholas L Mills, David E Newby, Alasdair Gray, Keith A A Fox, Colin Berry, Simon Walker, Paul O Collinson, Fred S Apple, Alan Reid, Anne Cruikshank, Iain Findlay, Shannon Amoils (independent), David A McAllister, Donogh Maguire, Jennifer Stevens (independent), John Norrie (independent), and Christopher Weir. Adjudication panel: Anoop S V Shah, Atul Anand, Andrew R Chapman, Kuan Ken Lee, Jack P M Andrews, Philip D Adamson, Alastair Moss, Mohamed S Anwar, John Hung, and Nicholas L Mills. Biochemistry subgroup committee: Simon Walker, Jonathan Malo, Alan Reid, Anne Cruikshank, and Paul O Collinson. Data monitoring committee: Colin M Fischbacher, Bernard L Croal, and Stephen J Leslie. Edinburgh Clinical Trials Unit: Catriona Keerie, Richard A Parker, Allan Walker, Ronnie Harkess, Christopher Tuck, Tony Wackett, and Christopher Weir. NHS Greater Glasgow and Clyde Safe Haven: Roma Armstrong, Laura Stirling, Claire MacDonald, Imran Sadat, and Frank Finlay. NHS Lothian Research Governance, e-Health and Safe Haven: Heather Charles, Pamela Linksted, Stephen Young, Bill Alexander, and Chris Duncan.Extra material supplied by authorsSupplementary information: Supplementary eText 1, eTables 1-5, and eFigures 1-4Contributors: KKL and DD contributed equally. KKL, ASVS, and NLM conceived and designed the study. The High-STEACS Investigators acquired the data. KKL and DD performed the analysis. KKL, DD, AVF, ARC, DK, TF, AB, ML, CT, SS, RW, CT, FES, DEN, AA, ASVS, and NLM interpreted the data. KKL and NLM drafted the manuscript. KKL, DD, AVF, ARC, DK, TF, AB, ML, CT, SS, RW, CT, FES, DEN, AA, ASVS, and NLM revised the manuscript critically for important intellectual content. All authors provided their final approval of the version to be published. All authors are accountable for the work. KKL, DD, and NLM are the study guarantors. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.Funding: This trial was funded by the British Heart Foundation (BHF, SP/12/10/29922). KKL and DD are supported by the BHF (FS/18/25/33454) and Medical Research Council (MR/N013166/1), respectively. DMK is supported by a BHF intermediate basic science research fellowship (FS/IBSRF/23/25161). DEN is supported by the BHF (RE/18/5/34216, CH/09/002, RG/F/22/110093). NLM is supported by a chair award, programme grant, and research excellence award (CH/F/21/90010, RG/20/10/34966, RE/18/5/34216) from the BHF. This work was supported by DataLoch (Competing interests: All authors have completed the ICMJE uniform disclosure form at The lead author (KKL) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.Dissemination to participants and related patient and public communities: Findings of this study will be shared with clinicians and patients through national and international cardiology conferences, and through social media platforms. A plain language summary will also be disseminated through a press release.Provenance and peer review: Not commissioned; externally peer reviewed.