- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00334373
Post Conditioning in PCI for Acute ST Elevation Myocardial Infarction
The purpose of this trial is to compare post-conditioning to standard angioplasty (50/50 chance) in patients who present with an acute heart attack and are taken directly for an angioplasty procedure. Post conditioning is a procedure that involves balloon inflation followed by deflation in a series of cycles that appears to show (based on early data) that it can decrease the amount of damage to the heart muscle as compared to standard angioplasty procedures.
Hypothesis: For Subjects undergoing direct PCI for STEMI, post conditioning with cycles of balloon inflation/deflation within the first minute following the re-establishment of coronary blood blow, will decrease the amount of irreversible myocardial damage assessed by delayed enhancement contrast CMR.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
In patients who suffer a myocardial infarction, the blood flow usually ceases due to plaque rupture leading to thrombus formation and vessel occlusion. The resultant entity is known as ST Elevation segment myocardial infarction (STEMI) and is a significant health issue in industrialized countries. There are over 50,000 STEMI's every year in Canada and up to 10% of these patients die in hospital and another 10% die within the first year after their heart attack. The more common problem however is not death, but irreparable damage to the left ventricle leading to LV dysfunction and subsequent heart failure and arrythmias. Re-establishing blood flow promptly by administering plasminogen activators (lytics) or mechanically by performing angioplasty is possible and has lowered the mortality rate dramatically.
Although reperfusion is necessary, it gives rise to an entity known as ischemia-reperfusion where acutely re-establishing blood flow and oxygen levels of the heart has detrimental effects. Clinically this is manifested as no-reflow that causes subsequent damage to the left ventricle and decreases the beneficial affect of early reperfusion by PCI. The ischemia-reperfusion effect sets off a molecular cascade of events involving unfavorable interaction between neutrophils, platelets and endothelium, that is fairly well identified. Efforts to pharmacologically block this effect have not proven to be particularly effective.
Post conditioning follows from a concept of pre-conditioning in animals that showed a decrease in myocardial infarct size. Pre-conditioning is not useful as it requires to be performed prior to the development of ischemia/injury. Post conditioning in preliminary studies with animals and one small study in humans have shown promising results for decrease in infarct size. Post conditioning is a procedure of gradual conditioning in which the artery is opened and closed in cycles with inflation/deflation of the culprit artery followed immediately by standard PCI and placement of stent.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
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Alberta
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Calgary, Alberta, Canada, T2N 2T9
- Foothills Medical Centre
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- 18 years and over
- ST elevation of >/= 2mm in 3 consecutive anterior leads or >/= to 2 mm in leads II, III and AVF with total 8 mm ST shift (ST depression of 1 mm in ant or lat leads)
Exclusion Criteria:
- Cardiogenic shock or severe heart failure
- Inability to undergo CMR (metallic objects or claustrophobia)
- Previous MI
- TIMI 2-3 flow in target artery
- Collaterals to infarct related artery > Rentrop grade 1
- Inability to undertake successful PCI at time of angio
- Significant LM disease or requiring CABG during hospital stay
- Inability to proceed with post conditioning within 1 minute of establishing blood flow in culprit artery
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Post conditioning
Balloon inflations-deflations
|
4 cycles of balloon inflation /deflation (post-conditioning) within first minute of opening up artery in primary PCI for STEMI vs usual balloon inflation sequence
|
Placebo Comparator: Standard care
No balloon inflations
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4 cycles of balloon inflation /deflation (post-conditioning) within first minute of opening up artery in primary PCI for STEMI vs usual balloon inflation sequence
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Infarct size as measured by: salvage index = total area at risk - infarct size/total area at risk
Time Frame: 3-5 days post MI
|
3-5 days post MI
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Corrected TIMI frame count (cTFC)
Time Frame: Immediately post PCI
|
Immediately post PCI
|
Myocardial blush score
Time Frame: Immediately post PCI
|
Immediately post PCI
|
CK release (under the curve)
Time Frame: 1st 48 hours post MI
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1st 48 hours post MI
|
ST segment resolution by 48 hrs compared with admission
Time Frame: 1st 48 hours post MI
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1st 48 hours post MI
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MRI infarct size
Time Frame: 3-5 days and 6 months
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3-5 days and 6 months
|
MRI maximal transmural extent of irreversible injury
Time Frame: 3-5 days and 6 months
|
3-5 days and 6 months
|
CMR regional end-systolic wall stress
Time Frame: 3-5 days and 6 months
|
3-5 days and 6 months
|
CMR Myocardial perfusion
Time Frame: 3-5 days and 6 months
|
3-5 days and 6 months
|
CMR Myocardial oxygenation
Time Frame: 3-5 days and 6 months
|
3-5 days and 6 months
|
Peripheral endothelial function testing (brachial u/s and pulse arterial tonometry) in hospital
Time Frame: 3-5 days post MI
|
3-5 days post MI
|
CMR quantification of volume of no-reflow
Time Frame: 3-5 days and 6 months
|
3-5 days and 6 months
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Study Director: Mouhieddin Traboulsi, MD, University of Calgary, sub-investigator
- Study Chair: Matthias Friedrich, MD, Sub-investigator, Stephenson CMR Centre, FMC; 1403-29th St NW, Calgary; T2N 2T9
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- Ethics ID E-20039
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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José García de la AsunciónCompleted
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Tianjin Huanhu HospitalRecruitingAcute Ischemic Stroke | Large Vessel Occlusion | Endovascular ThrombectomyChina
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Minneapolis Heart Institute FoundationNational Heart, Lung, and Blood Institute (NHLBI)CompletedAcute Myocardial InfarctionUnited States