- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05705362
Simple Crossover Versus Side Branch Opening in Patients With Non-Left Main Bifurcation Lesion (CROSS-COBIS)
Randomized Controlled Trial of Simple CROSSsover Versus Side Branch Opening on Clinical Outcomes in Patients With Non-Left Main BIfurcation LeSion (CROSS-COBIS)
Hypothesis:
Simple crossover strategy would be non-inferior to SB opening strategy in the risk of target lesion failure (TLF) in patients with angiographically compromised SB (visually SB stenosis ≥50%) after provisional MV stenting for non-left main bifurcation lesion.
A total of 1000 patients (500 per each group) with the angiographically compromised SB (visually SB stenosis ≥50%) after provisional MV stenting for non-left main bifurcation lesion will be enrolled. Patients will be randomized to either the simple crossover strategy group or SB opening strategy group at the time of enrollment with 1:1 ratio. Stratified randomization according to participating center, clinical presentation (acute coronary syndrome or stable ischemic heart disease), and type of bifurcation lesions (true or non-true) will be performed.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Despite advances in stenting techniques and devices, percutaneous coronary intervention (PCI) for bifurcation lesions remains one of the most challenging and complex procedures. Current guidelines recommend 1-stenting with provisional side branch (SB) approach should be an initial treatment strategy for the bifurcation lesions, based on the previous results of several randomized trials. However, the standardization of the provisional strategy is limited. In particular, there is a recommendation on the treatment technique for SB when SB intervention is required, but It has not been decided in which cases SB treatment is necessary, in the latest European Bifurcation Club (EBC) consensus document.16 In previous studies, the criteria for performing SB opening after MV stent intervention in the 1-stenting with provisional SB approach were varied. In the DK-CUSH II (Double Kissing Crush versus Provisional Stenting Technique for Treatment of Coronary Bifurcation Lesions) or CACTUS (Coronary Bifurcations: Application of the Crushing Technique Using Sirolimus-Eluting Stents) trials, SB intervention was performed when the SB diameter stenosis more than 50%, grade B or higher dissection, or blood flow disturbance (TIMI flow 2 or less) after MV stent insertion. On the other hand, in the Nordic trial, the authors applied strict criteria for SB intervention after MV stent insertion (TIMI flow 2 or less only). Furthermore, there have been conflicting results regarding the clinical and angiographic outcomes of the jailed SB opening strategy after the main vessel (MV) stenting, compared with the simple crossover strategy for non-left main bifurcation lesion.
On this background, this trial aims to compare the clinical outcomes between simple crossover and side branch opening strategies in patients with the angiographically compromised SB (visually SB stenosis ≥50%) after provisional MV stenting for non-left main bifurcation lesion.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Chang-Wook Nam, MD
- Phone Number: 82-53-258-7019
- Email: namcwcv@gmail.com
Study Contact Backup
- Name: Ki Hong Choi
- Phone Number: 82-2-3410-6653
- Email: cardiokh@gmail.com
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- (1) Subject must be at least 19 years of age
- (2) Patients with non-left main bifurcation lesion (SB diameter ≥2.3 mm)
- (3) Target lesions amenable for 1-stenting with provisional SB approach by operators' decision
- (4) Angiographically compromised SB (visual SB stenosis ≥50%) after provisional MV stenting
Exclusion Criteria:
- (1) Target lesions requiring elective 2-stenting technique by operators' decision (Observation Group 1)*
(2) Patients who inevitably require SB intervention after MV stenting, as follows. (Observation Group 2)*
- Reduced SB TIMI flow (≤2) after MV stenting
- SB dissection after MV stenting (≥ Type C)
- (3) Patients without SB compromise after MV stenting (visually SB stenosis <50%) (Observation Group 3)*
- (4) Cardiogenic shock (Killip class IV) at presentation
- (5) Patients with significant valvular heart disease or severe left ventricular systolic dysfunction (ejection fraction <35%)
- (6) Pregnancy or breast feeding
- (7) Non-cardiac co-morbid conditions are present with life expectancy <1 year or that may result in protocol non-compliance (per site investigator's medical judgment)
- (8) Unwillingness or inability to comply with the procedures described in this protocol
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 |
---|---|
Experimental: Simple crossover arm
This arm will receive the main vessel stenting only (with proximal optimization technique).
|
Regardless of allocated arms, stent implantation in the MV (selected 1:1 according to the distal MV size) followed by systematic proximal optimization technique (POT, post-dilatation of the stent at the level of proximal MV with a balloon diameter sized 1:1 according to the proximal MV) or POT like procedure is strongly recommended.
|
Active Comparator: Side branch opening arm
This arm will receive a side branch opening procedure after the main vessel stenting.
|
According to the latest European Bifurcation Club (EBC) consensus document, distal SB rewiring followed by kissing balloon inflation (eventually conducted with short non-compliant balloons) and repeat POT procedures are highly recommended.
An additional stent will be allowed if major dissection or decreased TIMI flow of SB occurs during SB treatment.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Target-lesion failure
Time Frame: up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
a composite of cardiac death, myocardial infarction, and target-lesion revascularization
|
up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
All-cause death
Time Frame: up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
Death from any causes
|
up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
Cardiac death
Time Frame: up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
Death from cardiac causes
|
up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
Myocardial infarction
Time Frame: up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
any myocardial infarction
|
up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
Target-vessel myocardial infarction
Time Frame: up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
myocardial infarction in target-vessel
|
up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
Target-lesion revascularization
Time Frame: up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
Clinically indicated target-lesion revascularization
|
up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
Target-vessel revascularization
Time Frame: up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
Clinically indicated target-vessel revascularization
|
up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
Any revascularization
Time Frame: up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
Repeat revascularization procedure
|
up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
Stent thrombosis
Time Frame: up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
definite or probable stent thrombosis by Academic Research Consortium [ARC] definition
|
up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
Bleeding
Time Frame: up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
Bleeding ARC type 2, 3 or 5 bleeding
|
up to 2 years of median follow-up (till 1 year after the last patient enrollment)
|
Total procedure time
Time Frame: at 1 day
|
procedure time
|
at 1 day
|
Total amount of contrast use
Time Frame: at 1 day
|
used contrast amount
|
at 1 day
|
Incidence of contrast induced nephropathy
Time Frame: 72 hours after the index procedure
|
defined as an increase in creatinine of ≥0.5mg/dL or ≥25% from baseline within 72 hours after contrast exposure
|
72 hours after the index procedure
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- CROSS-COBIS
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
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