- ICH GCP
- Registro de ensayos clínicos de EE. UU.
- Ensayo clínico NCT01247545
Effect of Remote Ischaemic Preconditioning on Clinical Outcomes in CABG Surgery (ERICCA)
Effect of Remote Ischaemic Preconditioning on Clinical Outcomes in Coronary Artery Bypass Graft Surgery
Coronary heart disease (CHD) is the leading cause of death in the UK, accounting for 124,000 deaths (2006) and costing the UK economy over £7.9 billion a year. Patients with severe CHD are usually treated by coronary artery bypass graft (CABG) surgery, the risks of which are increasing due to older and sicker patients being operated on. New treatment strategies are therefore required to improve health outcomes in these high-risk patients undergoing CABG with or without valve (CABG±valve) surgery.
The hypothesis tested in this research proposal is that remote ischaemic preconditioning (RIC), a virtually cost-free, non-pharmacological and simple non-invasive strategy for reducing the damage to the heart muscle at the time of surgery, improves health outcomes in high-risk patients undergoing CABG±valve surgery.
In this research project, 1610 high-risk patients undergoing CABG±valve surgery will be recruited via 28 UK hospitals performing heart surgery. Patients will be randomly allocated to receive either RIC or control. For RIC, a blood pressure cuff will be placed on the upper arm to temporarily deprive it of oxygen and nutrients, an intervention which has been shown in the investigators pilot studies to reduce damage to the heart muscle by up to 40% during CABG±valve surgery. The investigators will determine whether RIC can improve health outcomes in terms of better patient survival, less heart attacks and strokes, shorter hospital stay; less damage to the heart, kidney and brain during surgery; better heart function post-surgery and less chance of developing heart failure; better exercise tolerance and quality of life.
Descripción general del estudio
Estado
Condiciones
Intervención / Tratamiento
Tipo de estudio
Inscripción (Actual)
Fase
- Fase 3
Contactos y Ubicaciones
Ubicaciones de estudio
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Blackpool, Reino Unido
- Blackpool Victoria Hospital
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Cambridge, Reino Unido
- Papworth Hospital
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Cardiff, Reino Unido
- Cardiff & Vale University Health Board
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Edinburgh, Reino Unido
- Edinburgh Royal Infirmary
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Glasgow, Reino Unido
- Golden Jubilee Hospital
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Harefield, Reino Unido
- Harefield Hospital
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Hull, Reino Unido
- Castle Hill Hospital
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Leicester, Reino Unido
- Glenfield Hospital
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London, Reino Unido
- Royal Brompton Hospital
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London, Reino Unido
- St George's Hospital
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London, Reino Unido
- Hammersmith Hospital
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London, Reino Unido
- St Bartholomew's Hospital
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London, Reino Unido
- St Thomas Hospital
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London, Reino Unido
- Kings College London Hospital
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London, Reino Unido
- London Chest Hospital
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London, Reino Unido
- UCLH Heart Hospital
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Manchester, Reino Unido
- Manchester Royal Infirmary
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Manchester, Reino Unido
- Wythenshawe Hospital
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Manchester, Reino Unido
- John Radcliffe Hospital
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Newcastle, Reino Unido
- Freeman Hospital
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Nottingham, Reino Unido
- Trent Cardiac Centre
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Plymouth, Reino Unido
- Derriford Hospital
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Sheffield, Reino Unido
- Northern General Hospital
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Southampton, Reino Unido
- Southampton General Hospital
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Swansea, Reino Unido
- Swansea Hospital
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Wolverhampton, Reino Unido
- Wolverhampton Hospital
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Essex
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Basildon, Essex, Reino Unido
- Essex Cardiothoracic Centre
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Sussex
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Brighton, Sussex, Reino Unido
- Royal Sussex County Hospital
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Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Descripción
Inclusion Criteria:
- Patients undergoing CABG with or without valve surgery using blood cardioplegia
- Patients aged 18 years and above
- Patients with an additive Euroscore greater than or equal to 5
Exclusion Criteria:
- Cardiogenic shock
- Cardiac arrest on current admission
- Pregnancy
- Significant peripheral arterial disease affecting the upper limbs
- Patients with significant hepatic dysfunction (Prothrombin>2.0 ratio)
- Patients with significant pulmonary disease (FEV1<40% predicted)
- Patients with known renal failure with a GFR<30 mL/min/1.73 m2
- Patients on glibenclamide or nicorandil, as these medications may interfere with RIC
- Patients recruited into another study which may impact on the ERICCA study
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación de un solo grupo
- Enmascaramiento: Triple
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
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Comparador de placebos: Control
Control treatment (sham RIC) will consist of four 5-minute simulated inflations of a blood pressure cuff placed on the upper arm.
The inflations will be separated by 5-minute periods when the blood pressure cuff will be deflated.
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Control treatment (sham RIC) will consist of four 5-minute simulated inflations of a blood pressure cuff placed on the upper arm.
The inflations will be separated by 5-minute periods when the blood pressure cuff will be deflated.
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Comparador activo: Remote ischaemic conditioning
Blood pressure cuff placed on upper arm and inflated to 200mmHg for 5 minutes then deflated for 5 minutes - this cycle is repeated a total of 4 times.
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Blood pressure cuff placed on upper arm and inflated to 200mmHg for 5 minutes then deflated for 5 minutes - this cycle is repeated a total of 4 times.
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¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
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Major adverse cardiac and cerebral events
Periodo de tiempo: One year post-surgery
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Combined endpoint of Cardiovascular death, MI, Revascularisation and Stroke.
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One year post-surgery
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Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
---|---|---|
Peri-operative myocardial injury
Periodo de tiempo: 72 hours peri-operative period
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72 hours area under curve serum troponin-T
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72 hours peri-operative period
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LV ejection fraction
Periodo de tiempo: At one year
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Echo determined LV ejection fraction
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At one year
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Acute kidney injury
Periodo de tiempo: Peri-operative
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Acute kidney injury score and 24 hour area under curve serum NGAL
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Peri-operative
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30 day MACCE
Periodo de tiempo: 30 days post surgery
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Major adverse cardiac and cerebral events 30 days post surgery
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30 days post surgery
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All cause death
Periodo de tiempo: 1 year post surgery
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1 year post surgery
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Length of ITU stay
Periodo de tiempo: ITU stay
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ITU stay
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Length of hospital stay
Periodo de tiempo: Until hospital discharge
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Until hospital discharge
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Inotrope score
Periodo de tiempo: 72 hours post surgery
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Inotrope score after 72 hours
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72 hours post surgery
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6 minute Walk Test
Periodo de tiempo: 6 weeks and 12 months post surgery
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6 weeks and 12 months post surgery
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Quality of Life
Periodo de tiempo: 6 weeks, 3/6/9 and 12 months post surgery
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Quality of Life assessed using the EQ-5D measurement
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6 weeks, 3/6/9 and 12 months post surgery
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Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Derek J Hausenloy, MD PhD, University College, London
Publicaciones y enlaces útiles
Publicaciones Generales
- Hausenloy DJ, Mwamure PK, Venugopal V, Harris J, Barnard M, Grundy E, Ashley E, Vichare S, Di Salvo C, Kolvekar S, Hayward M, Keogh B, MacAllister RJ, Yellon DM. Effect of remote ischaemic preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery: a randomised controlled trial. Lancet. 2007 Aug 18;370(9587):575-9. doi: 10.1016/S0140-6736(07)61296-3.
- Venugopal V, Laing CM, Ludman A, Yellon DM, Hausenloy D. Effect of remote ischemic preconditioning on acute kidney injury in nondiabetic patients undergoing coronary artery bypass graft surgery: a secondary analysis of 2 small randomized trials. Am J Kidney Dis. 2010 Dec;56(6):1043-9. doi: 10.1053/j.ajkd.2010.07.014. Epub 2010 Oct 25.
- Hausenloy DJ, Yellon DM. Remote ischaemic preconditioning: underlying mechanisms and clinical application. Cardiovasc Res. 2008 Aug 1;79(3):377-86. doi: 10.1093/cvr/cvn114. Epub 2008 May 2.
- Candilio L, Malik A, Ariti C, Barnard M, Di Salvo C, Lawrence D, Hayward M, Yap J, Roberts N, Sheikh A, Kolvekar S, Hausenloy DJ, Yellon DM. Effect of remote ischaemic preconditioning on clinical outcomes in patients undergoing cardiac bypass surgery: a randomised controlled clinical trial. Heart. 2015 Feb;101(3):185-92. doi: 10.1136/heartjnl-2014-306178. Epub 2014 Sep 24.
- Venugopal V, Hausenloy DJ, Ludman A, Di Salvo C, Kolvekar S, Yap J, Lawrence D, Bognolo J, Yellon DM. Remote ischaemic preconditioning reduces myocardial injury in patients undergoing cardiac surgery with cold-blood cardioplegia: a randomised controlled trial. Heart. 2009 Oct;95(19):1567-71. doi: 10.1136/hrt.2008.155770. Epub 2009 Jun 8.
- Hausenloy DJ, Candilio L, Evans R, Ariti C, Jenkins DP, Kolvekar S, Knight R, Kunst G, Laing C, Nicholas J, Pepper J, Robertson S, Xenou M, Clayton T, Yellon DM; ERICCA Trial Investigators. Remote Ischemic Preconditioning and Outcomes of Cardiac Surgery. N Engl J Med. 2015 Oct 8;373(15):1408-17. doi: 10.1056/NEJMoa1413534. Epub 2015 Oct 5.
- Hausenloy DJ, Candilio L, Laing C, Kunst G, Pepper J, Kolvekar S, Evans R, Robertson S, Knight R, Ariti C, Clayton T, Yellon DM; ERICCA Trial Investigators. Effect of remote ischemic preconditioning on clinical outcomes in patients undergoing coronary artery bypass graft surgery (ERICCA): rationale and study design of a multi-centre randomized double-blinded controlled clinical trial. Clin Res Cardiol. 2012 May;101(5):339-48. doi: 10.1007/s00392-011-0397-x. Epub 2011 Dec 21.
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio
Finalización primaria (Actual)
Finalización del estudio (Actual)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Estimar)
Actualizaciones de registros de estudio
Última actualización publicada (Estimar)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- 10/0303
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