Stentys Coronary Stent System Clinical Trial in Patients With Acute Myocardial Infarction (APPOSITION V)

APPOSITION V: Stentys Coronary Stent System Clinical Trial in Patients With Acute Myocardial Infarction

This study will test compare the Stentys Stent with the Multi-Link Vision™ stent system (Abbott Vascular Inc.)in patients with a heart attack. It is expected that the Stentys stent is not worse than the Vision stent.

Study Overview

• Status: Terminated
• Conditions: Acute Myocardial Infarction
• Intervention / Treatment: Device: STENTYS self-apposing stent; Device: VISION balloon-expandable stent

Detailed Description

Coronary artery disease continues to be the most common cause of morbidity and mortality in the occidental world. Treatment of coronary atherosclerotic disease has been significantly advanced by interventional cardiology, and in particular the advent of coronary arterial stents. In comparison to angioplasty alone, stents have reduced the incidence of angiographic as well as clinical restenosis, the recurrence of angina, the need for coronary arterial bypass graft (CABG) surgery, the need for repeat revascularization and the occurrence of major adverse cardiac events (MACE).However,problems remain due to failure to achieve optimal stent apposition and normal myocardial reperfusion. Early stent malapposition may be due to incomplete expansion or undersizing of balloon-expandable stents. Several studies have emphasized the importance of early malapposition in the setting of ST elevation MI, in which substantial thrombotic burden and the presence of diffuse vasoconstriction may be contributory. The Stentys Coronary Stent System includes a self-expanding bare metal (nitinol) stent on a rapid exchange (RX) delivery system. In view of the theoretical implications of malapposition, the self-expanding property may offer a potential benefit.

This study is designed to evaluate the safety and effectiveness of the Stentys Coronary Stent System in the treatment of de novo stenotic lesions in coronary arteries in patients undergoing primary revascularization due to AMI as compared to the Multi-Link Vision™ coronary stent system (Abbott Vascular Inc. The study is powered for non-inferiority of the Stentys Coronary Stent System compared to the Vision Stent System.

• Study Type: Interventional
• Enrollment (Actual): 318
• Phase: Phase 3

Contacts and Locations

Study Locations

• Netherlands
  • Amsterdam, Netherlands
    • AMC
• United States
  • California
    • La Jolla, California, United States, 92037
      • Foundation Cardiovascular medicine
  • New York
    • New York, New York, United States, 10029
      • Mount Sinai Hospital

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:

General Inclusion Criteria

1. Subject ≥ 18 years old.
2. Subject experiencing clinical symptoms consistent with AMI of >30 min. in duration.
3. ST elevation ≥1 mm in ≥2 contiguous leads or new left bundle branch block, or true posterior MI with ST depression of ≥1 mm in ≥2 contiguous anterior leads.
4. Symptom duration is <12 hours prior to signing informed consent.
5. Subject should be in catheterization laboratory and procedure started within 2 hours of consent.
6. Patient provides written informed consent.
7. Patient agrees to all required follow-up procedures and visits.

Angiographic Inclusion Criteria

1. Based on coronary anatomy, PCI is indicated for the culprit lesion with anticipated use of stenting.
2. The vessel diameter is either known or expected to be 2.5-4.0mm, without excessive tortuosity or diffuse distal disease.

3. Lesion length ≥12mm and ≤ 23mm

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Exclusion Criteria:

General Exclusion Criteria

1. Currently enrolled in another investigational device or drug trial that has not completed the primary endpoint or that clinically interferes with the current study endpoints.
2. A previous coronary interventional procedure of any kind within 30 days prior to the procedure.
3. Female patients of childbearing potential known to be pregnant.
4. Patients undergoing cardiopulmonary resuscitation.
5. Cardiogenic shock (SBP <80 mmHg for >30 minutes, or requiring IV pressors or emergency IABP for hypotension).
6. The subject requires multivessel PCI at time of index procedure or any staged procedure of the target vessel within 9 months or any non-target vessel within 30 days post-procedure.
7. The target lesion requires treatment with a device other than PTCA prior to stent placement (such as, but not limited to, directional coronary atherectomy, excimer laser, rotational atherectomy, etc.). Thrombus aspiration may be used per operator discretion.
8. Attempted thrombolysis.
9. Co-morbid condition(s) that could limit the subject's ability to participate in the trial or to comply with follow-up requirements, or impact the scientific integrity of the trial.
10. Concurrent medical condition with a life expectancy of less than 12 months.
11. Known left ventricular ejection fraction (LVEF) < 25% at the most recent evaluation (prior to the index hospitalization).
12. History of cerebrovascular accident or transient ischemic attack in the last 6 months.
13. Active peptic ulcer or active gastrointestinal (GI) bleeding.
14. History of bleeding diathesis or coagulopathy or inability to accept blood transfusions.
15. Known hypersensitivity or contraindication to aspirin, heparin or bivalirudin, clopidogrel or ticlopidine, cobalt, nickel, or sensitivity to contrast media, which cannot be adequately pre-medicated.
16. Known serum creatinine level > 2.5 mg/dl, eGFR <30, or hemodialysis dependent.

Angiographic Exclusion Criteria

1. Unprotected left main coronary artery disease (obstruction greater than 60% in the left main coronary artery that is not protected by at least one non-obstructed bypass graft to the left anterior descending (LAD) or left circumflex (LCX) artery or a branch thereof).
2. Multi-vessel intervention required during the index procedure.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: STENTYS self-apposing stent; Intervention to treat STEMI with the STENTYS self-apposing stent	Device: STENTYS self-apposing stent; Intervention to treat STEMI with the STENTYS self-apposing stent
Active Comparator: VISION balloon-expandable stent; STEMI treatment with a VISION balloon-expandable stent	Device: VISION balloon-expandable stent; STEMI treatment with a VISION balloon-expandable stent --------------------------------------------------------------------------------

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Target Vessel Failure	From date of randomization until the date of first documented TVF, assessed up to 12 months.	12 months.

Secondary Outcome Measures

Outcome Measure	Time Frame
Acute Stent Malapposition	Immediately after procedure

Collaborators and Investigators

• Sponsor: Stentys
• Investigators: Principal Investigator: Roxana Mehran, MD, Mount Sinai Hospital, New York NY; Principal Investigator: Maurice Buchbinder, MD, Fouyndation Cardiovascular Research, La Jolla, CA

Publications and helpful links

General Publications

• Grundeken MJ, Lu H, Mehran R, Cutlip DE, Leon MB, Yeung A, Koch KT, Montalescot G, van Geuns RJ, Spaargaren R, Buchbinder M. APPOSITION V: STENTYS coronary stent system clinical trial in subjects with ST-segment elevation myocardial infarction--rationale and design. Am Heart J. 2014 Nov;168(5):652-60. doi: 10.1016/j.ahj.2014.07.011. Epub 2014 Jul 24.

Study record dates

Study Major Dates

• Study Start: May 1, 2013
• Primary Completion (Actual): December 1, 2015
• Study Completion (Actual): March 1, 2017

Study Registration Dates

• First Submitted: November 2, 2012
• First Submitted That Met QC Criteria: November 18, 2012
• First Posted (Estimate): November 22, 2012

Study Record Updates

• Last Update Posted (Actual): April 20, 2017
• Last Update Submitted That Met QC Criteria: April 19, 2017
• Last Verified: November 1, 2015

More Information

Terms related to this study

• Keywords: STEMI; BMS; Self-expanding stent
• Additional Relevant MeSH Terms: Ischemia; Pathologic Processes; Necrosis; Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Vascular Diseases; Myocardial Infarction; Infarction
• Other Study ID Numbers: STENTYS