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Beyond 12 Hours Reperfusion AlternatiVe Evaluation Trial (Brave-2)

24. september 2008 opdateret af: Deutsches Herzzentrum Muenchen

An International, Multicenter, Randomized Trial Assessing the Value of Mechanical Reperfusion in Patients With Acute Myocardial Infarction Presenting > 12 Hours From Onset of Symptoms

The objective of this international, multicenter, randomized study is to assess whether coronary artery stenting is associated with a reduced infarct size in patients with AMI presenting between 12 and 48 hours after onset of symptoms compared to medical treatment alone

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Between 8.5% and 40% of patients with acute myocardial infarction present late after symptom onset, no longer being eligible for thrombolysis.Despite efforts to reduce time to presentation, recent studies have demonstrated that time-to-arrival has not changed.The lack of efficacy of thrombolysis in patients with acute MI presenting > 12 hours after symptom onset may be a reason why current guidelines oppose reperfusion therapy in this setting.Several findings suggest, however,that reperfusion therapy may be beneficial even among these patients. First, recent studies have shown that viable salvageable myocardium exists even after >12 hours of severe ischemia. Second, previous studies have not only demonstrated that PCI is better than thrombolysis in patients with acute MI,but also that the time window of efficacy for PCI may be wider than that for thrombolysis.Third, observational studies suggest that PCI is effective even when performed after 12 hours from symptom onset in patients with acute MI. The goal of our trial was to assess whether an invasive strategy based on PCI with stenting is associated with reduction of infarct size in patients with acute STEMI presenting > 12 hours after symptom onset compared with a conventional conservative treatment strategy.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

365

Fase

  • Fase 4

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Italien
      • Florence, Italien
        • Azienda Ospedaliera Careggi
      • Mestre, Italien
        • Ospedale, "Umberto I"
  • Tyskland
      • Bad Reichenhall, Tyskland
        • Staedtisches Krankenhaus Bad Reichenhall
      • Erding, Tyskland, 85435
        • Kreiskrankenhaus Erding/Dorfen
      • Freilassing, Tyskland
        • Kreiskrankenhaus Freilassing
      • Fuerstenfeldbruck, Tyskland
        • Kreisklinik Fuerstenfeldbruck
      • Garmisch-Partenkirchen, Tyskland, 82467
        • Klinikum Garmisch-Partenkirchen
      • Munich, Tyskland, 80636
        • Deutsches Herzzentrum Muenchen
      • Munich, Tyskland, 81675
        • 1st Medizinische Klinik, Klinikum rechts der Isar
      • Ruhpolding, Tyskland
        • Krankenhaus Vinzentinum Ruhpolding
      • Schongau, Tyskland
        • Krankenhaus Schongau
      • Traunstein, Tyskland, 83278
        • Klinikum Traunstein
      • Trostberg, Tyskland
        • Kreisklinik Trostberg
  • Østrig
      • Feldkirch, Østrig
        • Landeskrankenhaus Feldkirch

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år til 80 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • patients fulfilling the criteria of AMI and presenting at the hospital between 12 and 48 hours after onset of symptoms. The criteria of AMI are fulfilled when at least one episode of typical chest pain lasting ≥ 20 minutes is combined with either unequivocal ECG changes (≥ 0.1 mV of ST-segment elevation in ≥ 2 limb leads or ≥ 0.2 mV in ≥ 2 contiguous precordial leads or new pathological Q-waves) or CK plus concomitant CK-MB increase above twice the upper normal threshold. All patients have to be informed of the nature of the study and should give their informed consent for participation in the study.

Exclusion Criteria:

  • Age <18 years and > 80 years
  • Cardiogenic shock (systolic blood pressure < 80 mm Hg unresponsive to fluids or necessitating the infusion of catecholamines: GUSTO I criteria)
  • Persistent severe chest pain
  • Prior thrombolysis (for index AMI)
  • Malignancies with life expectancy < 1year
  • History of bleeding diathesis, coagulopathy
  • Contraindications to the antithrombotic therapy used in conjunction with coronary stenting (clopidogrel and abciximab)
  • Stroke within the past 3 months
  • Major surgery within the past 30 days
  • Platelets < 100000/mm3 or >700000/mm3, Hb < 10g/dl, white blood cell count <3000/mm3
  • Percutaneous coronary intervention within the past 30 days
  • Inability to cooperate with study procedures and/or follow-up
  • Previous enrollment in this trial

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: A
Interventional treatment group - Patients assigned to PCI will receive the loading dose of clopidogrel, aspirin plus a bolus of heparin and be transferred immediately for interventional treatment. They will receive abciximab as a bolus followed by a continuous infusion of for 12 hours.
Andet: Interventional treatment group
Patients assigned to PCI will receive the loading dose of clopidogrel (300 mg), 500 mg aspirin plus a bolus of 70 U/kg heparin i.v. and be transferred immediately for interventional treatment. They will receive abciximab as a bolus of 0.25 mg/Kg of body weight followed by a continuous infusion of 0.125 µg/Kg/minute (up to a maximal dose of 10 µg/minute) for 12 hours. All patients will undergo coronary angiography and left ventriculography in the conventional way. During the procedure patients will receive the weight-adjusted heparin doses (70 U/ kg). Post-procedural antithrombotic therapy will consist of clopidogrel in a daily dose of 75 mg for at least 4 weeks (6 months recommended) and aspirin, 100 mg to 350 mg daily, indefinitely.
Aktiv komparator: B
Conservative treatment group - Patients assigned to this group will receive the usual therapy in the intensive care unit of the admitting hospital according to local standards.
Andet: Conservative treatment group
Patients assigned to this group will receive the usual therapy in the intensive care unit of the admitting hospital according to local standards. Per protocol, all patients in this arm will receive a loading dose of clopidogrel (300 mg) followed by 75 mg/day for at least 4 weeks (6 months recommended) after randomization and aspirin, indefinitely. Recommended additional regimen will include heparin, ß-blockers, ACE inhibitors and statins

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Tidsramme
The primary endpoint of the study is the infarct size calculated as the final perfusion defect (% of left ventricle) at the scintigraphic study
Tidsramme: 5-10 days
5-10 days

Sekundære resultatmål

Resultatmål
Tidsramme
Secondary endpoint of the study is the composite of all-cause death, recurrent MI, or stroke within 30 days after randomization.
Tidsramme: 30 days
30 days

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Deutsches Herzzentrum Muenchen

Samarbejdspartnere

Technical University of Munich

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. maj 2001

Primær færdiggørelse (Faktiske)

1. januar 2005

Studieafslutning (Faktiske)

1. august 2005

Datoer for studieregistrering

Først indsendt

24. september 2008

Først indsendt, der opfyldte QC-kriterier

24. september 2008

Først opslået (Skøn)

25. september 2008

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Skøn)

25. september 2008

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

24. september 2008

Sidst verificeret

1. september 2008

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • GE IDE No. I00800

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

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Betingelser

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Placeringer

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