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Effectiveness of Thrombus Aspiration in Plaque Reduction for Patients With Acute Coronary Syndromes (REMNANT)

4. juni 2015 opdateret af: Raffaele De Caterina

REduction of Myocardial Necrosis Achieved With Nose-dive Manual Thrombus Aspiration

Although successful, percutaneous coronary interventions (PCI) with stent implantation may be hampered by periprocedural myocardial necrosis. In acute ST-elevation myocardial infarction (STEMI), the reduction of thrombus burden through manual thrombus aspiration (TA) of an occluded coronary artery has been documented to produce an improved myocardial perfusion rate and significant survival advantage. To date, beyond feasibility and safety studies no clinical benefit has been yet documented with the use of TA before stent deployment in the setting of acute coronary syndromes (ACS) outside acute STEMI. The investigators hypothesize that TA before stent deployment reduces the thrombus/plaque burden - as assessed by intravascular imaging systems - in the setting of acute coronary syndromes (ACS) outside acute STEMI.

Studieoversigt

Status

Afsluttet

Betingelser

Detaljeret beskrivelse

Periprocedural myocardial infarction (MI) has an independent adverse prognostic relevance. Several trials have documented a reduction in the occurrence of periprocedural MI through various pharmacological strategies, with enhanced inhibition of platelet aggregation or high dose statins. However, real-world registries still document an incidence of periprocedural MI in 30-40% of patients. Currently available intravascular imaging techniques, Intravascular Ultrasound (IVUS) and more recently available Optical Coherence Tomography (OCT) allow a precise evaluation of the coronary plaque and can be extremely useful for monitoring plaque modifications obtained with thrombus aspiration (TA). Plaque burden will be assessed as plaque + media (P+M), commonly measured with IVUS by subtracting lumen (L) to external elastic membrane (EEM) cross sectional area (P+M= EEM-L).

Expecting a mean plaque volume of 160±50 mm3 in a population of patients with ACS undergoing PCI, a sample size of at least 45 patients (52 lesions) with a recent (<15 days, but after 24 hours) STEMI or a non-ST elevation (NSTE)-ACS within 72 hours of symptoms would provide a 90% power to detect a 20% reduction in the plaque volume after TA with an alpha (probability value) of 0.05.

Undersøgelsestype

Observationel

Tilmelding (Faktiske)

76

Kontakter og lokationer

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

Studiesteder

  • Italien
      • Chieti, Italien, 66013
        • Center of Predictive Molecular Medicine - University "G. d'Annunzio"
      • Chieti, Italien, 66100
        • Institute of Cardiology, G. d'Annunzio University
      • Rome, Italien, 00184
        • San Giovanni Hospital and Centro per la Lotta Contro l'Infarto, Fondazione Onlus

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 75 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Prøveudtagningsmetode

Sandsynlighedsprøve

Studiebefolkning

45 patients with at least one "culprit" lesion, identified as a high-grade (>90%) lesion in the territory of jeopardized myocardium, at coronary angiography performed for a recent (<15 days, but after 24 hours) STEMI or a non-ST elevation (NSTE)-ACS within 72 hours of symptoms.

Beskrivelse

Inclusion Criteria:

  • Age between 18-75 years old.
  • Recent(<15 days, >24 hrs)STEMI or NSTE-ACS within 72 hrs of symptoms.
  • Presence at least one "culprit" high-grade (>90%)lesion.

Exclusion Criteria:

  • STEMI within 24 hours.
  • Cardiogenic shock, decompensated heart failure, LVEF<30%.
  • Serum creatinine ≥ 2.5 mg/dl.
  • Contraindication to aspirin, heparin, thienopyridines.
  • Total occlusion of target vessel.
  • Diseased vein graft or a restenosis.

Studieplan

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

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
The change in plaque volume as assessed by intravascular ultrasound (IVUS).
Tidsramme: From baseline to 10 minutes after thromboaspiration (TA)
The reduction of plaque volume after TA, assessed as (Baseline P+M)- (Post-TA P+M);
From baseline to 10 minutes after thromboaspiration (TA)

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Histopathology assessment of aspirated material.
Tidsramme: One week after PCI
Quantitative analysis: size and weight. Qualitative evaluation: a) thrombus containing only platelets, b) a thrombus with an erythrocyte component c) any fragment of vessel wall, cholesterol crystals, inflammatory cells or collagen tissue.
One week after PCI
Myocardial infarct size by markers of myocardial injury/necrosis
Tidsramme: Up to 72 hours after PCI
Myocardial infarct size will be determined as the area under the curve of serial CK-MB and cardiac Troponin I assessment
Up to 72 hours after PCI
The change in thrombus burden as assessed by Optical Coherence Tomography (OCT)
Tidsramme: From baseline to 10 minutes after thromboaspiration (TA)
Thrombus burden will be assessed with a semiquantitative scale (0-4) by OCT at baseline and after TA
From baseline to 10 minutes after thromboaspiration (TA)

Samarbejdspartnere og efterforskere

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

Sponsor

Raffaele De Caterina

Samarbejdspartnere

San Giovanni Addolorata Hospital

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. marts 2011

Primær færdiggørelse (Faktiske)

1. september 2011

Studieafslutning (Faktiske)

1. oktober 2011

Datoer for studieregistrering

Først indsendt

12. april 2011

Først indsendt, der opfyldte QC-kriterier

26. april 2011

Først opslået (Skøn)

27. april 2011

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Skøn)

8. juni 2015

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

4. juni 2015

Sidst verificeret

1. juni 2015

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • 2010-021835-15

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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