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HEAT-PPCI – ten years on

Ten years ago this month, at the annual meeting of the American College of Cardiology, held in Washington DC, researchers from LHCH presented the results of a clinical trial that would go on to have a massive, international impact both on cardiology care and on approaches to how clinical research is performed.

HEAT-PPCI (How Effective are Anti-thrombotic Therapies in Primary Percutaneous Coronary Intervention) was a single-centre randomised controlled trial - conceived, planned, performed and reported by LHCH.  It compared two different drugs that were both in routine use around the world, competing to be the anti-coagulant of choice, for use at the time of emergency PCI for heart attack patients.  The headline results of the trial showed that the cheaper of the two agents was at least as good as (possibly better than) the alternative that cost about 400-800 times as much.  The resulting cost savings were substantial, saving about $700 million each year in the USA and about £500,000 annually in LHCH.  The results of the study were subsequently replicated in other studies from Scandinavia and clinical guidelines on both sides of the Atlantic were changed to reflect the findings.

Perhaps just as importantly, the study pioneered some novel approaches to clinical research – HEAT was:

  • at that time, the largest ever single-centre trial in the world history of cardiovascular medicine (only now surpassed by our more recent ARCH trial)
  • the only trial to have recruited a true consecutive series of all patients presenting with the condition of interest (every patient – every time) and this makes it more likely that the trial results will reflect everyday clinical needs (a concept called external validity or generalisability)
  • an exemplar in approaches to patient consent for research in emergency settings
  • a unique venture with all members of our clinical teams working together to deliver the research vision.

On the 70th anniversary of the foundation of the NHS, the National Institute for Health and Care Research (NIHR), as a special celebratory event, named the 70 greatest NHS research achievements over those years.  We can take great pride in the fact that HEAT-PPCI was included in this auspicious list – a testament to the commitment, dedication and professionalism of the many hundreds of our staff who worked so hard to deliver a world first, with global, massive impact for patients, for health-care costs and for research development.  

The HEAT-PPCI team are pictured at the American College of Cardiology Annual Meeting in 2014.