- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02939976
Study of Access Site for Enhancing PCI in STEMI for Seniors (SAFE STEMI for Seniors)
Patients with partially blocked blood vessel(s) in their heart may need a medical procedure called "Percutaneous Coronary Intervention (PCI)" to open the narrowed blood vessel(s). The purpose of this study is to simultaneously address four potential advances in ST-Elevation Myocardial Infarction (STEMI) care for patients at least 65 years old. The investigators are looking to see if these advances can improve the outcome for these patients.
- Opening the arteries with a Medtronic stent
- Radial access (from wrist) success with a Medtronic stent
- Checking the percent of blockage in the diseased artery/arteries using Volcano guide wires.
- Reduced bleeding and vascular complications with radial arterial access for primary PCI in STEMI.
Study Overview
Status
Conditions
Intervention / Treatment
- Device: Single Vessel Disease
- Device: Medtronic Resolute family of stents
- Device: Terumo Glidesheath Slender
- Device: Terumo TR Band Radial Compression Device
- Procedure: Multi-vessel Disease, Culprit Vessel Only
- Procedure: Multi-vessel Disease, Complete Revascularization
- Device: Volcano based pressure wires Verrata, Verrata Plus and any subsequent marketed Volcano pressure wire technology
Detailed Description
Multicenter, randomized, open-label, unblinded, active and historical-controlled trial in which approximately 875 seniors undergoing urgent PCI from approximately 70 centers will be enrolled. All consented subjects will undergo attempted radial arterial access.
For DES (Drug Eluting Stent) eligible patients without randomization exclusion criteria and with multi-vessel disease identified during initial angiogram will be randomized by site in a ratio of 1:1 to IRA-only revascularization or iFR-guided complete revascularization. After randomization, subjects with stable TIMI-3 flow established in the IRA using the protocol specified treatment will proceed with the randomized procedure. Subjects in whom IRA reperfusion with TIMI-3 flow is not achieved will be treated according to clinical best practice standard of care independent of randomized procedure assignment and will not be considered protocol violations. These patients will be followed identically to all study patients.
After stent implantation, subjects will be contacted for follow-up at 30 days by the enrolling site and at 1 year by the DCRI Call Center.
Primary endpoint results will be reported after all subjects have completed 1 year (12 months) of clinical follow-up.
STEMI patients eligible for radial access:
- DES Eligible with single vessel Coronary Artery Disease (CAD) will receive DES to IRA
- DES Eligible with Multi-vessel CAD will randomize 1:1 to IRA-only revascularization or Instantaneous Wave Free Radio (iFR)-guided complete revascularization
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
North Carolina
-
Durham, North Carolina, United States, 27715
- Duke Clinical Research Institute
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria
- Have the capacity to understand and sign an informed consent or have a Legally Authorized Representative that can understand and sign an informed consent prior to initial arteriotomy access.
- Age ≥ 60 years of age at the time of signing the informed consent and/or randomization.
- Significant ST-elevation myocardial infarction or left bundle branch block (LBBB) on ECG with chest pain < 12 hours.
- Accessible right or left radial artery conduit for PCI.
- Physician intent to perform trans-radial PCI.
- Willing to be contacted at 1 year by the DCRI Call Center
Study Randomization Inclusion Criteria
To be eligible for randomization in the 'IRA only vs. Complete Revascularization' phase of this trial, subjects must meet all of the above criteria and all of the following criteria subsequent to arterial access:
- Subject eligible for DES implantation.
- Angiographic multi-vessel CAD determined by local visual estimation.
Exclusion Criteria
- Patient that have known medical conditions that would prevent or interrupt the recommended post procedure DES treatment regimen.
- Patients that have known medical conditions that would prevent catheterization through the radial artery.
- Patients that have known medical conditions that increase patient's risk above standard when using IFR.
- Has had a cerebrovascular accident or transient ischemic neurological attack within the past 6 months.
- Known history of substance abuse (alcohol, cocaine, heroin, etc.) that may cause noncompliance with the protocol.
- Any condition associated with a life expectancy of less than 1 year.
- Participation in another clinical study using an investigational agent or device within the past 3 months.
Study Randomization Exclusion Criteria If a subject who has been consented into the SAFE STEMI study develops or is found to have any of the following, they will not be eligible for randomization to an iFR guided complete revascularization vs. IRA-only primary PCI and will be excluded from the study.
- Shock requiring pressors or mechanical circulatory assist support (IABP, Impella, ECMO, etc.) significant chronic renal disease (eGFR < 30) and/or on dialysis.
Other angiographic exclusions:
- Single vessel CAD
- Unprotected left main coronary artery disease
- One or more major coronary distributions with CTO or indeterminate IRA
- Clinical circumstances, which, in the judgment of the operator, preclude randomization.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Single Vessel Disease
Standard of care comparator for those subjects with single vessel coronary artery disease.
Revascularization with Medtronic Resolute family of stents in infarct related artery; Possible use of Terumo Glidesheath Slender and Terumo TR Band Radial Compression Device
|
Revascularization with Medtronic Resolute family of stents in infarct related artery; Possible use of Terumo Glidesheath Slender and Terumo TR Band Radial Compression Device
Revascularization with Medtronic Resolute family of stents in infarct related artery
Possible use of Terumo Glidesheath Slender
Possible use of Terumo TR Band Radial Compression Device
|
Experimental: Multi-vessel Disease, Culprit Vessel Only
Subjects randomized to revascularization of infarct related artery only.
Revascularization with Medtronic Resolute family of stents in infarct related artery; Possible use of Terumo Glidesheath Slender and Terumo TR Band Radial Compression Device
|
Revascularization with Medtronic Resolute family of stents in infarct related artery
Possible use of Terumo Glidesheath Slender
Possible use of Terumo TR Band Radial Compression Device
Revascularization with Medtronic Resolute family of stents in infarct related artery; Possible use of Terumo Glidesheath Slender and Terumo TR Band Radial Compression Device
|
Experimental: Multi-vessel Disease, Complete Revascularization
Subjects randomized to complete revascularization.
Complete revascularization of all diseased arteries with Medtronic Resolute family of stents; Use of Volcano based pressure wires Verrata, Verrata Plus and any subsequent marketed Volcano pressure wire technology to determine which arteries to stent; Possible use of Terumo Glidesheath Slender and Terumo TR Band Radial Compression Device
|
Revascularization with Medtronic Resolute family of stents in infarct related artery
Possible use of Terumo Glidesheath Slender
Possible use of Terumo TR Band Radial Compression Device
Complete revascularization of all diseased arteries
Complete revascularization of all diseased arteries
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Adjudicated 1-year infarct-related artery Major Adverse Cardiac and Cerebrovascular Event (MACE)
Time Frame: 1 year
|
Defined as cardiac death, infarct artery target-vessel MI, or ischemia-driven index infarct related vessel revascularization (IIVR) by percutaneous or surgical methods.
|
1 year
|
Adjudicated 1-year Complete versus Lesion-only Primary PCI trial (CvLPRIT) MACE
Time Frame: 1 year
|
Defined as all-cause mortality, recurrent MI, heart failure (requiring hospitalization or 12 hour ER visit) or ischemia-driven revascularization for all treated arteries.
|
1 year
|
Primary Observational Endpoint - Estimate of the incidence rate of Radial Artery Occlusion (RAO)
Time Frame: During procedure
|
Stratified by whether or not the Terumo TR Band was employed (use of the TR Band is recommended not required)
|
During procedure
|
Primary Observational Endpoint - Estimate of the incidence rate of Radial Artery Occlusion (RAO)
Time Frame: 30 day
|
Stratified by whether or not the Terumo TR Band was employed (use of the TR Band is recommended not required)
|
30 day
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Adjudicated Death (all causes)
Time Frame: Day 1
|
Efficacy endpoint
|
Day 1
|
Adjudicated Death (all causes)
Time Frame: 30 days
|
Efficacy endpoint
|
30 days
|
Adjudicated Death (all causes)
Time Frame: 1 year
|
Efficacy endpoint
|
1 year
|
Adjudicated Cardiac Death
Time Frame: Day 1
|
Efficacy endpoint
|
Day 1
|
Adjudicated Cardiac Death
Time Frame: 30 days
|
Efficacy endpoint
|
30 days
|
Adjudicated Cardiac Death
Time Frame: 1 year
|
Efficacy endpoint
|
1 year
|
Adjudicated Nonfatal (re-) MI
Time Frame: 30 days
|
Efficacy endpoint
|
30 days
|
Adjudicated Nonfatal (re-) MI
Time Frame: 1 year
|
Efficacy endpoint
|
1 year
|
Adjudicated Index Infarct Related vessel (re-) MI
Time Frame: 30 days
|
Efficacy endpoint
|
30 days
|
Adjudicated Index Infarct Related vessel (re-) MI
Time Frame: 1 year
|
Efficacy endpoint
|
1 year
|
Adjudicated Index Infarct Related Lesion Revascularization (IILR) (ischemia driven)
Time Frame: 30 days
|
Efficacy endpoint
|
30 days
|
Adjudicated Index Infarct Related Lesion Revascularization (IILR) (ischemia driven)
Time Frame: 1 year
|
Efficacy endpoint
|
1 year
|
Adjudicated Index Infarct Vessel Revascularization (IIVR) (ischemia driven)
Time Frame: 30 days
|
Efficacy endpoint
|
30 days
|
Adjudicated Index Infarct Vessel Revascularization (IIVR) (ischemia driven)
Time Frame: 1 year
|
Efficacy endpoint
|
1 year
|
Adjudicated Academic Research Consortium (ARC) definite/probable stent thrombosis
Time Frame: Post-Procedure
|
Safety endpoint
|
Post-Procedure
|
Adjudicated Academic Research Consortium (ARC) definite/probable stent thrombosis
Time Frame: 30 days
|
Safety endpoint
|
30 days
|
Adjudicated Academic Research Consortium (ARC) definite/probable stent thrombosis
Time Frame: 1 year
|
Safety endpoint
|
1 year
|
Adjudicated Academic Research Consortium (ARC) definite stent thrombosis
Time Frame: Post-procedure
|
Safety endpoint
|
Post-procedure
|
Adjudicated Academic Research Consortium (ARC) definite stent thrombosis
Time Frame: 30 days
|
Safety endpoint
|
30 days
|
Adjudicated Academic Research Consortium (ARC) definite stent thrombosis
Time Frame: 1 year
|
Safety endpoint
|
1 year
|
Adjudicated stroke
Time Frame: Post-procedure
|
Post-procedure
|
|
Adjudicated stroke
Time Frame: 30 days
|
30 days
|
|
Adjudicated stroke
Time Frame: 1 year
|
1 year
|
|
Adjudicated Infarct Related vessel (re-P2) MI
Time Frame: Day 1
|
Day 1
|
|
Adjudicated Infarct Related vessel (re-P2) MI
Time Frame: 30 days
|
30 days
|
|
Heart failure (requiring hospitalization or 12 hour ER visit)
Time Frame: Day 1
|
Day 1
|
|
Heart failure (requiring hospitalization or 12 hour ER visit)
Time Frame: 30 days
|
30 days
|
|
Heart failure (requiring hospitalization or 12 hour ER visit)
Time Frame: 1 year
|
1 year
|
|
Ischemia-driven revascularization for index infarct vessel revascularization (IIVR) or any treated index non-infarct related vessels (INIVR)
Time Frame: 1 year
|
1 year
|
|
iFR guided revascularization - Site reported index hospitalization bleeding and vascular complication defined as bleeding or vascular co
Time Frame: During procedure
|
During procedure
|
|
iFR guided revascularization with Volcano based pressure wires Verrata®, Verrata Plus® and any subsequent marketed Volcano pressure wire technology - total procedure time
Time Frame: During procedure
|
During procedure
|
|
iFR guided revascularization with Volcano based pressure wires Verrata®, Verrata Plus® and any subsequent marketed Volcano pressure wire technology - total contrast used
Time Frame: During procedure
|
During procedure
|
|
iFR guided revascularization with Volcano based pressure wires Verrata®, Verrata Plus® and any subsequent marketed Volcano pressure wire technology - occurrence of renal insufficiency
Time Frame: 48-72 hours post-procedure
|
48-72 hours post-procedure
|
|
iFR guided revascularization with Volcano based pressure wires Verrata®, Verrata Plus® and any subsequent marketed Volcano pressure wire technology - occurrence of renal insufficiency
Time Frame: 30 days
|
30 days
|
|
Terumo TR Band - Site reported time to achieve hemostasis
Time Frame: Post-procedure
|
Secondary Observational Endpoint
|
Post-procedure
|
Terumo TR Band - Incidence rate of cross over from the initial access point to another stratified by whether or not Terumo Slender GlideSheath was employed (use of the GlideSheath Slender is recommended not required)
Time Frame: Day 1
|
Secondary Observational Endpoint
|
Day 1
|
Terumo TR Band - Incidence rate of Access success defined as successfully deploying the stent through the right or left radial artery stratified by whether or not Terumo GlideSheath Slender was employed
Time Frame: Day 1
|
Secondary Observational Endpoint
|
Day 1
|
Terumo TR Band - incidence of RAO, stratified by whether or not the Terumo TR Band was employed in combination with GlideSheath Slender
Time Frame: Day 1
|
Secondary Observational Endpoint
|
Day 1
|
Terumo TR Band - incidence of RAO, stratified by whether or not the Terumo TR Band was employed in combination with GlideSheath Slender
Time Frame: 30 days
|
Secondary Observational Endpoint
|
30 days
|
Medtronic Resolute® Family of Stents - Site determination of Device success
Time Frame: During index procedure
|
Device performance endpoint
|
During index procedure
|
Medtronic Resolute® Family of Stents - Site determination of Lesion success
Time Frame: During index procedure
|
Device performance endpoint
|
During index procedure
|
Medtronic Resolute® Family of Stents - • Site determination of Procedure success
Time Frame: During index procedure in-hospitalization
|
Device performance endpoint
|
During index procedure in-hospitalization
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: David F Kong, MD, Duke University
- Study Chair: Mitchell W Krucoff, MD, Duke University
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- Pro00076262
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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.
Clinical Trials on Myocardial Infarction
-
Azienda ULSS 5 PolesanaUniversity of PadovaUnknownMyocardial Infarction, Acute | ST Segment Elevation Myocardial Infarction | Non-ST Elevation Myocardial Infarction (nSTEMI)Italy
-
University Medical Centre LjubljanaCompletedCardiac Arrest | Postresuscitation Syndrome | Myocardial Infarction (ST-Elevation Myocardial Infarction and Non-ST-Elevation Myocardial Infarction)Slovenia
-
Fundacio Privada Mon Clinic BarcelonaMiracor Medical SANot yet recruiting
-
Stiftung Institut fuer HerzinfarktforschungGlaxoSmithKline; University Hospital Muenster; Klinikum NürnbergCompletedMyocardial Infarction | ST-Elevation Myocardial Infarction | Non-ST-Elevation Myocardial InfarctionGermany
-
Bispebjerg HospitalOdense University Hospital; Zealand University Hospital; Hvidovre University... and other collaboratorsRecruitingST Elevation Myocardial Infarction | Acute Myocardial Infarction | Non-ST Elevation Myocardial Infarction (nSTEMI)Denmark
-
Population Health Research InstituteCanadian Institutes of Health Research (CIHR); Boston Scientific CorporationActive, not recruitingST Elevation Myocardial Infarction | Non ST Elevation Myocardial InfarctionCanada
-
University of LeedsUniversity College, LondonCompletedST-elevation Myocardial Infarction | Non ST-elevation Myocardial Infarction
-
Karolinska InstitutetUppsala University; The Swedish Research CouncilActive, not recruitingST Elevation Myocardial Infarction | Acute Myocardial Infarction | Non-ST Elevation Myocardial InfarctionSweden
-
Oslo University HospitalVestre Viken Hospital Trust; University of Oslo; University Hospital of North... and other collaboratorsActive, not recruitingST Elevation Myocardial Infarction | Acute Myocardial Infarction | Non-ST Elevation Myocardial InfarctionNorway
-
Barts & The London NHS TrustUniversity College, London; Queen Mary University of LondonCompletedAcute Myocardial InfarctionSwitzerland, Denmark, United Kingdom
Clinical Trials on Single Vessel Disease
-
Dartmouth-Hitchcock Medical CenterTerminated
-
OhioHealthIntuitive SurgicalCompleted
-
Kerckhoff KlinikCompletedCABG Graft IntegrityGermany
-
Dr. Martin LeitritzOptomedCompletedEye Diseases | Retina; Lesion | Optic Disc Structural AnomalyGermany
-
VA Office of Research and DevelopmentCompleted
-
Ziekenhuis Oost-LimburgNot yet recruitingArthroplasty Complications | Tensor Fasciae Latae SyndromeBelgium
-
Cook Group IncorporatedCompletedPeripheral Arterial Disease (PAD)
-
General University Hospital, PragueRecruitingMolecular Markers of Fibrosis of Single Types of Endometriosis and Their Use in Predicting Disease SeverityCzechia
-
Humacyte, Inc.Atlantic Research GroupCompletedPeripheral Artery DiseaseUnited States
-
Abbott Medical DevicesCompletedCardiovascular Disease | Peripheral Vascular DiseaseUnited States