Clinical outcomes following acute myocardial infarction and percutaneous coronary intervention in complex high-risk patient populations

Percutaneous coronary intervention (PCI) is the commonest form of revascularisation undertaken in the United Kingdom for patients with coronary artery disease in both the elective and emergency heart attack setting, with over 80,000 such procedures undertaken annually. Many of these procedures are undertaken for acute myocardial infarction that occurs in up to 100,000 patients annually. Whilst the long-term mortality outcomes following myocardial infarction and PCI are well described, most data around outcomes is derived from randomised controlled trials or registries in lower risk patient cohorts, that do not reflect multi-morbid elderly patients encountered routinely in clinical practice. Consequently, there is little data around peri-procedural and longer term outcomes such as heart failure, re-infarction or bleeding in higher-risk patient groups not recruited into trials and their outcomes from the national perspective. 

Aims

To study real world outcomes of patients presenting with an acute myocardial infarction and undergoing PCI in the United Kingdom using two national cardiovascular datasets, the British Cardiovascular intervention (BCIS) dataset that captures every PCI undertaken in the UK and the Myocardial Infarction National Audit Program (MINAP) registry linked to ONS and HES data. 

Objectives

1) To describe temporal trends in mortality over time following PCI and AMI and describe what has contributed to these in terms of clinical demographics, procedural factors, pharmacology and institutional factors stratified by i) PCI complexity ii) elective vs ACS iii) Patient demographics iv) AMI type

2) Describe the incidence, timing, nature and outcomes of post discharge complications / adverse outcomes such as heart failure and reinfarction and whether these can be predicted from clinical and procedural factors.

3) Develop risk stratification tools to predict adverse outcomes and complications, using a range of analytical methods, and potentially expanding existing models into a dynamic setting

Entry Requirements

Applicants are expected to hold (or about to obtain) a minimum upper second class undergraduate honours degree (or equivalent) in a related subject area. Understanding and experience of quantitative research study design and analysis of data and familiarity with, and experience of, statistical software packages, e.g. Stata, SPSS, R, SAS is essential. 

Desirable

A Master's degree in a relevant discipline

Experience in using and analysing routinely recorded healthcare data

Applicants interested in this project should make direct contact with the Primary Supervisor to arrange to discuss the project further as soon as possible.

How To Apply

To be considered for this Studentship you MUST submit a formal online application form - full details on how to apply can be found on https://www.bmh.manchester.ac.uk/study/research/apply/

Please select 'PhD Epidemiology’ under academic programme when completing your online application.

Equality, Diversity and Inclusion

Equality, diversity and inclusion is fundamental to the success of The University of Manchester, and is at the heart of all of our activities. The full Equality, diversity and inclusion statement can be found on the website https://www.bmh.manchester.ac.uk/study/research/apply/equality-diversity-inclusion/