Thrombus Aspiration in ThrOmbus Containing culpRiT Lesions in Non-ST-Elevation Myocardial Infarction (TATORT-NSTEMI)

May 1, 2017 updated by: Holger Thiele, University of Leipzig
Whereas thrombus aspiration in patients with ST-elevation myocardial infarction (STEMI) is recommended by current guidelines, there are insufficient data to unequivocally support thrombectomy in patients with non-STEMI (NSTEMI). The Thrombus Aspiration in ThrOmbus containing culpRiT lesions in Non-ST-Elevation Myocardial Infarction (TATORT-NSTEMI) trial is a 400 patient, prospective, controlled, multicenter, randomized, open-label trial. The hypothesis is that under the background of early revascularization, adjunctive thrombectomy in comparison to conventional percutaneous coronary intervention (PCI) alone leads to less microvascular obstruction (MO) assessed by cardiac magnetic resonance imaging (CMR) in patients with NSTEMI. Patients will be randomized in a 1:1 fashion to one of the two treatment arms. The primary endpoint is the extent of MO assessed by CMR. Secondary endpoints include infarct size and myocardial salvage assessed by CMR, enzymatic infarct size as well as angiographic parameters, such as Thrombolysis in Myocardial Infarction-flow post-PCI and myocardial blush grade. Furthermore, clinical endpoints including death, myocardial reinfarction, target vessel revascularization and new congestive heart failure will be recorded at 6 and 12 months. Safety will be assessed by bleeding and stroke. In summary, the TATORT-NSTEMI trial has been designed to test the hypothesis that thrombectomy will improve myocardial perfusion in patients with NSTEMI and relevant thrombus burden in the culprit vessel reperfused by early PCI.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Anticipated)

400

Phase

  • Phase 4

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

  • Germany
      • Bad Berka, Germany
        • Zentralklinik Bad Berka
      • Berlin, Germany
        • Unfallkrankenhaus Berlin
      • Frankfurt/Oder, Germany
        • Klinikum Frankfurt/Oder
      • Homburg, Germany
        • University of Saarland, Campus Homburg/Saar
      • Leipzig, Germany
        • University of Leipzig
      • Ludwigshafen, Germany
        • Institut für Herzinfarktforschung
      • Tübingen, Germany
        • University of Tübingen

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 90 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • ischemic symptoms such as angina pectoris >20 minutes
  • occurrence of last symptoms <72 h before randomization
  • cardiac troponin T or I levels above the 99th percentile
  • culprit lesion containing thrombus (TIMI-thrombus grade 2-5 within the lesion) and intended early PCI

Exclusion Criteria:

  • cardiogenic shock
  • STEMI
  • no identifiable culprit lesion or a TIMI-thrombus grade <2
  • coronary morphology ineligible for thrombectomy (e.g. very tortuous vessels, severe calcification)
  • indication for acute bypass surgery
  • age <18 and >90 years
  • contraindications for treatment with heparin, aspirin or thienopyridines
  • pregnancy
  • current participation in another clinical study
  • co-morbidity with limited life expectancy <6 months
  • contraindications to CMR at study entry

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

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Thrombectomy
Procedure: Thrombectomy
Manual thrombectomy will be performed in the thrombus aspiration group using an aspiration catheter utilized in daily clinical routine (Eliminate, Terumo Europe, Leuven, Belgium). In the standard PCI group, patients will be treated by conventional PCI according to local practice without thrombectomy.
Other: Standard percutaneous coronary intervention
In the standard percutaneous coronary intervention (PCI) group, patients will be treated by conventional PCI according to local practice without thrombectomy.
Procedure: Standard percutaneous coronary intervention
In the standard percutaneous coronary intervention (PCI) group, patients will be treated by conventional PCI according to local practice without thrombectomy.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Extent of late microvascular obstruction assessed by cardiac magnetic resonance imaging (CMR)
Time Frame: CMR performed within day 1 to 4 after randomization
CMR performed within day 1 to 4 after randomization

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Infarct size assessed by cardiac magnetic resonance imaging (CMR)
Time Frame: CMR performed within day 1 to 4 after randomization
CMR performed within day 1 to 4 after randomization
Myocardial salvage assessed by cardiac magnetic resonance imaging (CMR)
Time Frame: CMR performed within day 1 to 4 after randomization
CMR performed within day 1 to 4 after randomization
Left ventricular ejection fraction assessed by cardiac magnetic resonance imaging (CMR)
Time Frame: CMR performed within day 1 to 4 after randomization
CMR performed within day 1 to 4 after randomization
Thrombolysis in Myocardial Infarction (TIMI)-flow post-PCI
Time Frame: Immediately after percutaneous coronary intervention
Immediately after percutaneous coronary intervention
Myocardial blush grade
Time Frame: Immediately after percutaneous coronary intervention
Immediately after percutaneous coronary intervention
Troponin T
Time Frame: 24 and 48 hours after randomization
24 and 48 hours after randomization
Combined clinical endpoint
Time Frame: Follow-up performed at 6, 12 and approximately 60 months after randomization
Occurence of a combined clinical endpoint including death, re-infarction, target vessel revascularization and congestive heart failure will be recorded. Clinical outcome will be assessed by a telephone interview at 6 and 12 months. Any clinical event will be verified by hospital or general practitioner records.
Follow-up performed at 6, 12 and approximately 60 months after randomization
Assessment of quality of life
Time Frame: 6, 12 and approximately 60 months after randomization
6, 12 and approximately 60 months after randomization
Stroke and bleeding
Time Frame: Participants will be followed for the duration of hospital stay (an expected average of 5 days)
Participants will be followed for the duration of hospital stay (an expected average of 5 days)

Collaborators and Investigators

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

Sponsor

University of Leipzig

Investigators

  • Principal Investigator: Holger Thiele, MD, Heart Center Leipzig, University of Leipzig, Germany

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)

June 1, 2013

Study Completion (Actual)

October 1, 2016

Study Registration Dates

First Submitted

May 30, 2012

First Submitted That Met QC Criteria

June 1, 2012

First Posted (Estimate)

June 5, 2012

Study Record Updates

Last Update Posted (Actual)

May 2, 2017

Last Update Submitted That Met QC Criteria

May 1, 2017

Last Verified

May 1, 2017

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 070-11-07032011

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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