Efficacy of Extracorporeal Shockwave Myocardial Revascularization (ANGEL)

Hungarian Study on the Efficacy of Extracorporeal Shockwave Myocardial Revascularization in Patients With Therapy-refracter Angina Pectoris

Clinical research to justify effectiveness of the Extracorporeal Shockwave Myocardial Revascularization (ESMR) Therapy for treatment of patients with reversible myocardial ischemia secondary to Coronary Artery Disease (CAD) and therapy resistant stable angina pectoris.

Study Overview

• Status: Unknown
• Conditions: Refractory Angina Pectoris
• Intervention / Treatment: Device: device for Extracorporeal Shockwave Myocardial Revascularization (ESMR) therapy

• Study Type: Interventional
• Enrollment (Anticipated): 14
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Hungary
  • Budapest, Hungary
    • Recruiting
    • Kelen Hospital
    • Contact: Imre Lukács, MD; Phone Number: +36 20 914 7300; Email: luxi6@freemail.hu
    • Sub-Investigator: Imre Lukács, MD
  • Budapest, Hungary
    • Recruiting
    • Semmelweis University Heart Center
    • Contact: Béla Merkely, Prof; Phone Number: +36 1 4586840; Email: titkarsag@kardio.sote.hu
    • Sub-Investigator: Zoltán Jambrik, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Patient with a signed Informed Consent Form.
• Patient's current and past medical condition and status be assessed using previous medical history, complete physical examination and the physicians (principle investigator's) medical opinion.
• Patient is diagnosed with chronic angina pectoris for at least 6 weeks. Diagnosis is based on medical history, complete physical examination, and core labs.
• Patients who no longer receive benefit from additional revascularization procedures (i.e. CABG or Angioplasty). Certification will be made by Heart Team.
• Patient demonstrates Exercise Tolerance Time (ETT) duration < 10 minutes on Modified Bruce protocol.
• Patient had at least one documented myocardial segment with reversible ischemia.
• Patient is under optimum medical therapy for angina for at least 6 weeks. The optimal treatment plan is tailored to a person's age, the presence of other medical conditions, lifestyle, medication side effects, etc. Medical therapies for stable angina include ACE-inhibitors, Nitrates, Beta Blockers and Calcium Channel Blockers, trimetazidine, ivabradin. Combination of any of 3 above mentioned drugs will be considered as optimum medical therapy.
• Patient has an echocardiographic acoustic window to the target area in the myocardium utilizing one of the following views: apical 2 chamber view (2CH), apical 4 chamber view (4CH), modified parasternal long axis view (LAX) and parasternal short axis view (SAX).

Exclusion Criteria:

• Patient who will substantially benefit from additional revascularization procedures such as additional CABG or angioplasty therapies. This determination will be made and certified by the Heart Team.
• Patient has active endocarditis, myocarditis or pericarditis.
• Patient with moderately severe or severe valvular disease.
• Patient with known intraventricular thrombus.
• Patients who have active or non-active implantables, such as pacemakers, defibrillators, abandoned leads, or electrodes.
• Patient for who shock waves applied over any implanted device that releases substances or medications to the periphery (such as insulin pumps).
• Patient is pregnant.
• Patient with severe chronic lung disease (emphysema, pulmonary fibrosis) with difficult access to ultrasonic acoustic window.
• Patients for who shock waves applied over the area of healing fracture.
• Patients for who shock waves applied over the area of bone growth.
• Patients for who shock waves applied to the area of malignancy.
• Prior invasive malignancy, except non-melanomatous skin cancer or other malignancies with a documented disease-free survival for a minimum of 5 years.
• By the physician decision there is underlying concomitant disease or circumstance what may negatively influence the management of the patient.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: ESMR treated	Device: device for Extracorporeal Shockwave Myocardial Revascularization (ESMR) therapy; Other Names: Cardiospec system

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Improvement in myocardial ischaemia profile during dobutamine induced stress echocardiography	baseline and 6 months

Secondary Outcome Measures

Outcome Measure	Time Frame
Improvement in the angina pectoris CCS Stage	baseline and 3, 6 months
Improvement in angina status using Seattle Angina Questionnaire	baseline and 3, 6 months
The change in walking time using the modified Bruce exercise test	baseline and 3, 6 months
The change in basal transthoracal echocardiographic parameters	baseline and 3, 6 months
The decrease in nitrate use during the unchanged everyday activity reported by the patients in the "Nitrate Usage Log"	baseline and 3, 6 months

Collaborators and Investigators

• Sponsor: Salus Ltd.
• Investigators: Principal Investigator: Béla Merkely, Prof, Semmelweis University Heart Center

Study record dates

Study Major Dates

• Study Start: October 1, 2012
• Primary Completion (ANTICIPATED): September 1, 2013

Study Registration Dates

• First Submitted: October 16, 2012
• First Submitted That Met QC Criteria: October 17, 2012
• First Posted (ESTIMATE): October 22, 2012

Study Record Updates

• Last Update Posted (ESTIMATE): October 25, 2012
• Last Update Submitted That Met QC Criteria: October 24, 2012
• Last Verified: October 1, 2012

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Vascular Diseases; Pain; Neurologic Manifestations; Chest Pain; Angina Pectoris
• Other Study ID Numbers: ANGEL_v01