Timing of Complete Revascularization in Patients With ST-segment Elevation Myocardial Infarction And Multivessel Disease (TERMINAL)

February 8, 2022 updated by: Xiaotong Hou, Beijing Anzhen Hospital

Timing of Complete Revascularization in Patients With ST-segment Elevation Myocardial Infarction And Multivessel Disease-A Multi-center Randomized Controlled Trial

At present, the two treatment strategies of opening non infarct related arteries (non IRA) simultaneously or by stages after emergency percutaneous coronary intervention (PCI) in patients with acute ST segment elevation myocardial infarction (STEMI) complicated with multi vessel disease (MVD) are still controversial. In our previous retrospective analysis, there was no significant difference between complete revascularization (CR) and staged CR at Anzhen Hospital in the cases of cardiac death, reinfarction, stroke, proportion of revascularization and hospitalization rate of heart failure.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

The literature reports on the benefits of two CR strategies of opening non IRA simultaneously or by stages after IRA treatment in STEMI patients are inconsistent. This study intends to enroll 426 cases and divide into two groups to verify whether the occurrence of major cardiovascular adverse events (all-cause death, nonfatal myocardial infarction, ischemia driven revascularization and heart failure) in one year in immediately open non-IRA after successful emergency PCI of infarct related arteries in STEMI patients with MVD group is not inferior to staged (within 45 days) CR group. It can accumulate more evidence-based medical basis for the selection of better treatment schemes, so as to formulate optimized treatment schemes for clinic. To study when to open meaningful non IRA in acute STEMI complicated with MVD is of great guiding significance for CR after acute myocardial infarction. At the same time, it has important social significance and economic value for delaying or preventing cardiovascular events.

Study Type

Interventional

Enrollment (Anticipated)

426

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • China
    • Beijing
      • Beijing, Beijing, China, 100029
        • Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University

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:

  1. Onset of the spontaneous acute STEMI (24 hours).
  2. The anatomical structure of coronary artery is suitable for complete revascularization by PCI.
  3. It is suitable for PCI through radial artery or femoral artery.
  4. Be able to fully identify Infarct-related artery（IRA）.
  5. In addition to IRA, in the vessels of lumen diameter is 2.25mm or more, but less than 4.5mm. there is at least one non IRA's stenosis more than 70% observed in both planes, or 50% ~ 69% stenosis and fractional flow reserve (FFR) or Quantitative Flow Ratio (QFR) measured value is 0.80 or less.
  6. After IRA revascularization the thrombolysis in myocardial infarction (TIMI) blood flow is in grade 3.
  7. The hemodynamics of patients after IRA revascularization is stable, that is, systolic blood pressure ≥ 90mmHg, or blood pressure ≥ 90mmHg after catecholamines, and there is no clinical manifestation of hypoperfusion.
  8. Patient who has signed informed consent

Exclusion Criteria:

  1. Cardiogenic shock which means a group of clinical syndromes leading to cardiac dysfunction caused by various reasons, which meet the following criteria: A: continuous hypotension, systolic blood pressure < 90mmHg or mean arterial pressure decreased from baseline ≥ 30mmhg, more than 30min; B: cardiac index < 1.8l/min/m2, pulmonary congestion or elevated left ventricular filling pressure; c: Signs of organ perfusion damage (at least one): changes in mental state, wet and cold skin, oliguria, and increased serum lactic acid level.
  2. The duration of cardiopulmonary resuscitation is more than 10 minutes.
  3. Emergency coronary artery bypass grafting (CABG) is needed.
  4. Previous coronary-artery bypass grafting surgery.
  5. Hybrid revascularization is planned.
  6. Coronary dissection.
  7. Stent thrombosis.
  8. In stent restenosis, definition: A: target vessel diameter stenosis ≥ 50% at follow-up. b: The lumen loss at follow-up was larger than 50% of the net lumen gain after operation. c: The lumen diameter at follow-up and the minimum diameter loss measured immediately at stenting were 0.72 mm or more.
  9. Acute myocardial infarction complicated with severe mechanical complications, defined as acute severe mitral regurgitation, ventricular septal perforation and cardiac free wall rupture / pericardial tamponade.
  10. Severe renal failure (EGFR < 30ml / min) or dialysis treatment is required.
  11. Chronic total occlusion of main coronary artery.
  12. Complex bifurcation lesions requiring dual stent treatment.
  13. Stenosis of Left main coronary artery≥ 50% or stenosis of left anterior descending coronary artery and circumflex coronary artery ≥ 70%.
  14. Coronary, cerebrovascular or peripheral revascularization is planned.
  15. Cardiac surgery or other surgical treatment is planned.
  16. Contraindications to double antibody therapy [aspirin and P2Y12 inhibitor (clopidogrel or ticagrelor) for 3 months.
  17. pregnant woman.
  18. Patient who has participated in other clinical trials.
  19. Life expectancy < 1 year.
  20. Patient who is not suitable for inclusion in the study according to the operator's judgment.

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: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Immediately CR group
Immediately open non-IRA after successful emergency PCI of IRA in STEMI patients with MVD
Procedure: Immediately CR
Immediately opening non-IRA after emergency opening IRA in STEMI patients with MVD
Active Comparator: Staged (within 45 days) CR group
Strategy of opening non-IRA by stages after emergency PCI of IRA in STEMI patients with MVD
Procedure: Staged (within 45 days) CR
Staged opening non-IRA after emergency opening IRA in STEMI patients with MVD

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Major Adverse Cardiovascular Event
Time Frame: 1 year
Including All-cause death, Ischemia driven revascularization, Nonfatal myocardial infarction and Heart failure
1 year

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
All-cause death
Time Frame: 1 year
All reasons of death
1 year
Ischemia driven revascularization
Time Frame: 1 year
Myocardial ischemia needs to revascularize
1 year
Nonfatal myocardial infarction
Time Frame: 1 year
A kind of Myocardial infarction which does not lead to death
1 year
Heart failure
Time Frame: 1 year
Deterioration of heart function or acute heart failure
1 year
Cardiovascular related death
Time Frame: 1 year
Died of cardiovascular diseases
1 year
Stent thrombosis
Time Frame: 1 year
Thrombosis in stent
1 year
Dialysis or acute renal insufficiency
Time Frame: 1 year
Dialysis or acute renal insufficiency occurred after operation
1 year
Bleeding events
Time Frame: 1 year
Bleeding occurred after oral administration of dual antiplatelet drugs
1 year

Collaborators and Investigators

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

Sponsor

Beijing Anzhen Hospital

Collaborators

Beijing Chao Yang Hospital
Beijing Luhe Hospital

Investigators

  • Study Director: Hou, Beijing Anzhen Hospital

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 (Anticipated)

March 1, 2022

Primary Completion (Anticipated)

July 1, 2024

Study Completion (Anticipated)

December 1, 2024

Study Registration Dates

First Submitted

December 30, 2021

First Submitted That Met QC Criteria

February 8, 2022

First Posted (Actual)

February 9, 2022

Study Record Updates

Last Update Posted (Actual)

February 9, 2022

Last Update Submitted That Met QC Criteria

February 8, 2022

Last Verified

February 1, 2022

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2021-20

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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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