Effectiveness of Thrombus Aspiration in Plaque Reduction for Patients With Acute Coronary Syndromes (REMNANT)

June 4, 2015 updated by: Raffaele De Caterina

REduction of Myocardial Necrosis Achieved With Nose-dive Manual Thrombus Aspiration

Although successful, percutaneous coronary interventions (PCI) with stent implantation may be hampered by periprocedural myocardial necrosis. In acute ST-elevation myocardial infarction (STEMI), the reduction of thrombus burden through manual thrombus aspiration (TA) of an occluded coronary artery has been documented to produce an improved myocardial perfusion rate and significant survival advantage. To date, beyond feasibility and safety studies no clinical benefit has been yet documented with the use of TA before stent deployment in the setting of acute coronary syndromes (ACS) outside acute STEMI. The investigators hypothesize that TA before stent deployment reduces the thrombus/plaque burden - as assessed by intravascular imaging systems - in the setting of acute coronary syndromes (ACS) outside acute STEMI.

Study Overview

Status

Completed

Conditions

Detailed Description

Periprocedural myocardial infarction (MI) has an independent adverse prognostic relevance. Several trials have documented a reduction in the occurrence of periprocedural MI through various pharmacological strategies, with enhanced inhibition of platelet aggregation or high dose statins. However, real-world registries still document an incidence of periprocedural MI in 30-40% of patients. Currently available intravascular imaging techniques, Intravascular Ultrasound (IVUS) and more recently available Optical Coherence Tomography (OCT) allow a precise evaluation of the coronary plaque and can be extremely useful for monitoring plaque modifications obtained with thrombus aspiration (TA). Plaque burden will be assessed as plaque + media (P+M), commonly measured with IVUS by subtracting lumen (L) to external elastic membrane (EEM) cross sectional area (P+M= EEM-L).

Expecting a mean plaque volume of 160±50 mm3 in a population of patients with ACS undergoing PCI, a sample size of at least 45 patients (52 lesions) with a recent (<15 days, but after 24 hours) STEMI or a non-ST elevation (NSTE)-ACS within 72 hours of symptoms would provide a 90% power to detect a 20% reduction in the plaque volume after TA with an alpha (probability value) of 0.05.

Study Type

Observational

Enrollment (Actual)

76

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Italy
      • Chieti, Italy, 66013
        • Center of Predictive Molecular Medicine - University "G. d'Annunzio"
      • Chieti, Italy, 66100
        • Institute of Cardiology, G. d'Annunzio University
      • Rome, Italy, 00184
        • San Giovanni Hospital and Centro per la Lotta Contro l'Infarto, Fondazione Onlus

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 75 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Probability Sample

Study Population

45 patients with at least one "culprit" lesion, identified as a high-grade (>90%) lesion in the territory of jeopardized myocardium, at coronary angiography performed for a recent (<15 days, but after 24 hours) STEMI or a non-ST elevation (NSTE)-ACS within 72 hours of symptoms.

Description

Inclusion Criteria:

  • Age between 18-75 years old.
  • Recent(<15 days, >24 hrs)STEMI or NSTE-ACS within 72 hrs of symptoms.
  • Presence at least one "culprit" high-grade (>90%)lesion.

Exclusion Criteria:

  • STEMI within 24 hours.
  • Cardiogenic shock, decompensated heart failure, LVEF<30%.
  • Serum creatinine ≥ 2.5 mg/dl.
  • Contraindication to aspirin, heparin, thienopyridines.
  • Total occlusion of target vessel.
  • Diseased vein graft or a restenosis.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
The change in plaque volume as assessed by intravascular ultrasound (IVUS).
Time Frame: From baseline to 10 minutes after thromboaspiration (TA)
The reduction of plaque volume after TA, assessed as (Baseline P+M)- (Post-TA P+M);
From baseline to 10 minutes after thromboaspiration (TA)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Histopathology assessment of aspirated material.
Time Frame: One week after PCI
Quantitative analysis: size and weight. Qualitative evaluation: a) thrombus containing only platelets, b) a thrombus with an erythrocyte component c) any fragment of vessel wall, cholesterol crystals, inflammatory cells or collagen tissue.
One week after PCI
Myocardial infarct size by markers of myocardial injury/necrosis
Time Frame: Up to 72 hours after PCI
Myocardial infarct size will be determined as the area under the curve of serial CK-MB and cardiac Troponin I assessment
Up to 72 hours after PCI
The change in thrombus burden as assessed by Optical Coherence Tomography (OCT)
Time Frame: From baseline to 10 minutes after thromboaspiration (TA)
Thrombus burden will be assessed with a semiquantitative scale (0-4) by OCT at baseline and after TA
From baseline to 10 minutes after thromboaspiration (TA)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Raffaele De Caterina

Collaborators

San Giovanni Addolorata Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

March 1, 2011

Primary Completion (Actual)

September 1, 2011

Study Completion (Actual)

October 1, 2011

Study Registration Dates

First Submitted

April 12, 2011

First Submitted That Met QC Criteria

April 26, 2011

First Posted (Estimate)

April 27, 2011

Study Record Updates

Last Update Posted (Estimate)

June 8, 2015

Last Update Submitted That Met QC Criteria

June 4, 2015

Last Verified

June 1, 2015

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2010-021835-15

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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