Multimarker Evaluation of Platelet Activity and Agregation in ACS

Multimarker Evaluation of Platelet Activity and Agregation in Patients Presenting With Acute Coronary Syndrome: Prospective Observational Study

Patients with acute coronary syndrome (ACS) who undergo percutaneous coronary intervention (PCI) are at a higher risk of ischemic complications, even while receiving proper dual antiplatelet therapy. For this reason, identifying high-risk patients and personalizing treatment according to their profile could be a solution towards improving the efficacy and safety of the antiplatelet treatment.

This is a prospective single centre study analyzing correlations and clinical outcomes of patients in relation to biomarkers in acute coronary syndrome. The blood samples were collected from patients admitted to the hospital with a diagnosis of ACS and treated with dual antiplatelet therapy.

The blood samples were collected from each patient within the first 24 hours after the admission for acute coronary syndrome (ACS) and after 72 hours of hospitalization.

Study Overview

• Status: Completed
• Conditions: Acute Coronary Syndrome
• Intervention / Treatment: Other: Assesment of biomarkers in acute coronary syndromes

Detailed Description

In this prospective, single-center, observational study, adult patients meeting the inclusion/exclusion criteria were included. Subjects enrolled at the Invasive Cardiology Unit of the 1st Department of Cardiology; Medical University of Warsaw (Poland) were cathegorized into three arms: 1) treated with aspirin and clopidogrel, 2) treated with aspirin and ticagrelor; 3) treated with aspirin and prasugrel. In all three groups subjects first obtained the loading dose of the drug and thereafter they received a fixed daily dose.

Blood samples were collected form each patient at two time-points: during the first 24 hours from hospital admission and after 72 hours following hospital admission. The parameters measured included selected platelet-derived microRNAs prticles, immature platelet fraction (IPF) and platelet microvesicles' comncentration. Platelet reactivity was established using Multiplate® Analyzer (Roche).

• Study Type: Observational
• Enrollment (Actual): 150

Contacts and Locations

Study Locations

• Poland
  • Warsaw, Poland, 00-001
    • I Department and Clinic of Cardiology, Medical University of Warsaw

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Adult population diagnosed with ACS on admission and treated primarily with PCI.

Description

Inclusion Criteria:

1. Ability to provide written informed consent in a time window 1-24 hours after successful PCI;
2. Male or female, age ≥ 18 years at screening;
3. ACS at the time of the index hospitalization;
4. ACS patients undergoing PCI (New-Generation DES)
5. Use of a loading dose of P2Y12 inhibitor administered after diagnosis of ACS or after PCI;

Exclusion Criteria:

1. Unstable clinical status (hemodynamic or electrical instability);
2. Planned surgery requiring DAPT discontinuation during the study;
3. Coronary Revascularization (Surgical or Intervention) Program within 90 days
4. Prior stroke, transient ischemic attack or intracranial bleeding;
5. Active bleeding;
6. Severe anemia (hemoglobin < 8g/dL);
7. Platelet count ≤70x10^3/ml;
8. Hematocrit of < 30% or > 52%
9. Renal failure (hemodialysis or creatinine clearance ≤ 30 ml/min calculated with Cockroft-Gault formula);
10. Severe hepatic dysfunction (baseline alanine aminotransferase ≥ 2.5 times the upper limit of normal);
11. Known hypersensitivity or contraindication to ASA, clopidogrel, ticagrelor or prasugrel;
12. Under judicial protection, tutorship or curatorship;
13. Pregnancy;
14. Unable to understand and follow study-related instructions;
15. Enrollment in another investigational device or drug study.
16. Unable to provide an informed consent.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Assesment of platelet biomarkers in acute coronary syndromes - low level of parameters; Blood is collected within the first 24 hours from hospital admission and after 72 hours following hospital admission. The level of selected biomarkers is measured.	Other: Assesment of biomarkers in acute coronary syndromes; Collection of 20ml of blood from peripheral vein.
Assesment of platelet biomarkers in acute coronary syndromes - high level of parameters; Blood is collected within the first 24 hours from hospital admission and after 72 hours following hospital admission. The level of selected biomarkers is measured.	Other: Assesment of biomarkers in acute coronary syndromes; Collection of 20ml of blood from peripheral vein.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Correlation between the selected biomarkers in patients with acute coronary syndrome in the first 24 hours from hospital admission and major adverse cardiovascular events (MACE)	MACE defined as the composite endpoint of all-cause death, myocardial infarction, stroke, unplanned revascularization.	50 months

Collaborators and Investigators

• Sponsor: Medical University of Warsaw

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2017
• Primary Completion (Actual): December 1, 2022
• Study Completion (Actual): December 8, 2023

Study Registration Dates

• First Submitted: December 8, 2023
• First Submitted That Met QC Criteria: December 19, 2023
• First Posted (Estimated): December 20, 2023

Study Record Updates

• Last Update Posted (Estimated): December 20, 2023
• Last Update Submitted That Met QC Criteria: December 19, 2023
• Last Verified: December 1, 2023

More Information

Terms related to this study

• Keywords: Biomarkers; Acute Coronary Syndrome; Antiplatelet therapy; IPF; Immature Platelet Fraction; ADP test
• Additional Relevant MeSH Terms: Pathologic Processes; Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Vascular Diseases; Disease; Syndrome; Acute Coronary Syndrome
• Other Study ID Numbers: MULTIMARKER-ACS

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No