COMBinAtion Therapy in Myocardial Infarction: The COMBAT-MI Trial (COMBAT-MI)

November 2, 2020 updated by: Hospital Universitari Vall d'Hebron Research Institute
Remote ischemic conditioning (RIC) and intravenous exenatide administered immediately before primary angioplasty have been found to limit infarct size in patients with STEMI (ST segment elevation myocardial infarction), but the reduction is limited. This study investigates whether a combination therapy including both therapies is more effective.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

COMBAT-MI is an investigator-driven, randomized, double-blind and placebo-controlled clinical trial aimed at evaluating the effect of Remote Ischemic Conditioning and exenatide, alone and in combination, on Myocardial Infarct size in 428 STEMI patients (107 per group) (ST segment elevation myocardial infarction). Patients with TIMI (Thrombolysis in Myocardial Infarction) flow grade > 1 will be excluded. The study has a 2 x 2 factorial design (Remote Ischemic Conditioning , Exenatide, both or neither). The primary end-point will be Myocardial Infarct size measured by Cardiac Magnetic Resonance Imaging (CMRI) performed 3 - 7 days after primary Percutaneous Coronary Intervention (pPCI) (expressed as % of left ventricular (LV) mass). Sample size has been calculated in 274 patients with TIMI 0-1 available for analysis of the primary end-point, and inclusion will end when this number is reached, which will require, according to the current rate of TIMI 0-1 in our STEMI population, to randomize 428 patients. Secondary end-points will include myocardial salvage index, based on angiographic and CMRI derived estimations of the area at risk, and frequency of Major Adverse Cardiovascular Events (MACE) and of major adverse events during admission.

Study Type

Interventional

Enrollment (Actual)

378

Phase

  • Phase 3

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

  • Spain
      • Barcelona, Spain, 08035
        • Hospital Universitario Valle de Hebrón
      • Lleida, Spain, 25198
        • Hospital Universitario Arnau de Vilanova
      • Madrid, Spain, 28040
        • Hospital Universitario Fundacion Jimenez Diaz
      • Tarragona, Spain, 43005
        • Hospital Universitari de Tarragona Joan 23
    • Barcelona
      • Badalona, Barcelona, Spain, 08916
        • Hospital Universitari Germans Trias i Pujol
    • La Coruña
      • Santiago de Compostela, La Coruña, Spain, 15706
        • Hospital Clinico Universitario de Santiago de Compostela

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 and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Men or women ≥18 years of age
  • STEMI characterized by 2 mm ST segment elevation in 2 or more V1 through V4 leads or presumed new left bundle branch block with minimum of 1 mm concordant ST elevation or 1 mV(millivolt) ST segment elevation in the limb leads (II, III and aVF leads, I, aVL leads) and V4-V6.
  • Patients presenting within 6 hours of chest pain.

Exclusion Criteria:

  • Known hypersensitivity to exenatide or any of the excipients
  • Known contraindication to CMR imaging such as significant claustrophobia, severe allergy to gadolinium chelate contrast, severe renal insufficiency (defined as estimated glomerular filtration rate [eGFR] (epidermal growth factor receptor) <30 mL/min/1.73 m2), presence of CMRI contraindicated implanted devices (e.g., pacemaker, implanted cardiac defibrillator, cardiac resynchronization therapy device, cochlear implant), embedded metal objects (e.g., shrapnel), or any other contraindication for CMRI.
  • Assumed life expectancy < 1 year e.g. due to non-cardiac disease.
  • TIMI flow grade > 1 at the time of diagnostic coronary angiography. These patients will be excluded from the analysis of infarct size but will be included in the safety analysis.
  • Pregnant women
  • Patients with loss of consciousness or confused, not able to read the information and to sign the writting consent
  • Patients with oro-tracheal intubation
  • Patients with cardiogenic shock persisting 48h after reperfusion

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: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Remote Ischemic Conditioning
Remote Ischemic Conditioning + placebo
Other: Remote Ischemic Conditioning (RIC)
Remote ischemic conditioning with a cuff in the arm
Drug: Placebo
Intrevenous administration of Placebo
Active Comparator: Combined treatment
Remote Ischemic Conditioning + exenatide
Other: Remote Ischemic Conditioning (RIC)
Remote ischemic conditioning with a cuff in the arm
Drug: Exenatide
Intravenous administration of Exenatide
Placebo Comparator: Placebo
Sham Remote Ischemic Conditioning + placebo
Other: Remote Ischemic Conditioning (RIC)
Remote ischemic conditioning with a cuff in the arm
Drug: Placebo
Intrevenous administration of Placebo
Active Comparator: Exenatide
Sham Remote Ischemic Conditioning + exenatide
Other: Remote Ischemic Conditioning (RIC)
Remote ischemic conditioning with a cuff in the arm
Drug: Exenatide
Intravenous administration of Exenatide

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Myocardial Infarct Size
Time Frame: 3-7 days after pPCI
MI, measured by late gadolinium enhancement in CMRI 3-7 days after pPCI, and expressed as percent of left ventricular mass.
3-7 days after pPCI

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Major adverse cardiac events (MACE)
Time Frame: Hospital discharge and expected average of 1 week, one year follow-up
MACE rate during hospitalization, defined as death, non-fatal myocardial rupture, or appearance or worsening of heart failure during the hospitalization period and after 1 year of follow-up
Hospital discharge and expected average of 1 week, one year follow-up
Myocardial salvage index
Time Frame: 3-7 days after pPCI
Myocardial salvage index defined as the difference between infarct size and area at risk, defined by the T2 CMRI and expressed as a percent of total LV (Left Ventricular) mass, divided by the area at risk.
3-7 days after pPCI
Transmurality index
Time Frame: 3-7 days after pPCI
Transmurality index, defined as the ratio of the mass of myocardium showing late gadolinium enhancement to the mass of the myocardial segment containing it.
3-7 days after pPCI
Ventricular volumes
Time Frame: 3-7 days after pPCI
LV (Left Ventricular) end-diastolic volume and LVEF (Left Ventricular Ejection Fraction), as determined by CMRI.
3-7 days after pPCI
Microvascular obstruction
Time Frame: 3-7 days after pPCI
Volume of myocardium with microvascular obstruction determined by late gadolinium enhancement expressed as percent of infarct size.
3-7 days after pPCI
Markers of successful reperfusion
Time Frame: First 90 min after reperfusion
Markers of successful myocardial reperfusion: ST segment resolution 90 minutes post-pPCI , TIMI flow and frame-count post-pPCI , and TIMI blush grade .
First 90 min after reperfusion

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Substudy: Biomarker analysis in Hospital Universitari Vall d'Hebron Biobank (HUVH Biobank)
Time Frame: pre- pPCI
To find biomarkers of increased myocardial susceptibility to reperfusion injury in blood samples obtained before PCI
pre- pPCI
PRESPECIFIED SUBGROUP ANALYSIS ACCORDING TO TOTAL ISCHEMIC TIME
Time Frame: 3-7 days after pPCI
The effects of treatments will be analysed in the subgroup of patients with a total ischemic time of less than 3 hours and of 3 hours of longer.
3-7 days after pPCI

Collaborators and Investigators

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

Sponsor

Hospital Universitari Vall d'Hebron Research Institute

Investigators

  • Principal Investigator: Ignacio Ferreira González, MD, PhD, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca

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 (Actual)

March 1, 2016

Primary Completion (Actual)

August 1, 2019

Study Completion (Actual)

June 1, 2020

Study Registration Dates

First Submitted

March 20, 2015

First Submitted That Met QC Criteria

March 26, 2015

First Posted (Estimate)

March 31, 2015

Study Record Updates

Last Update Posted (Actual)

November 3, 2020

Last Update Submitted That Met QC Criteria

November 2, 2020

Last Verified

February 1, 2020

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • COMBAT-MI

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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