Endothelium, Stenting, and Antiplatelet Therapy (EST) - Clopidogrel, Prasugrel, Ticagrelor Study (EST)
4 septembre 2016 mis à jour par: Tommaso Gori, Johannes Gutenberg University Mainz
Effects of Clopidogrel vs Prasugel vs Ticagrelor on Endothelial Function, Inflammatory and Oxidative Stress Parameters and Platelet Function in Patients Undergoing Coronary Artery Stenting. A Randomised, Prospective Study.
Endothelial dysfunction is an important predictor - and a determinant - of adverse clinical outcome.
Endothelial function is impaired by coronary artery stenting, a stud from our group has shown that it can be improved by platelet inhibition using clopidogrel.
However, clopidogrel unresponsiveness is a known problem, and it has been show that the endothelial effects of clopidogrel tend to wane upon prolonged treatment.
Whether a more effective anti-platelet therapy is able to prevent/improve not only thrombotic events but also endothelial dysfunction, with potential positive impact on clinical outcome in patients undergoing coronary artery stenting, is an important hypothesis that needs to be further investigated.
To date, evidence regarding "ancillary" (non-platelet-dependent) effects of antiaggregant drugs is very limited.
For instance, while their antiplatelet effects, and their beneficial effects in patients with acute coronary syndromes, have been clearly demonstrated in multicentric trials, it remains to be shown whether these drugs also protect endothelial function.
Interestingly, some authors suggest that the mortality benefit observed in the PLATO study is at least in part independent of direct antiplatelet effects.
No study, to date, has tested the effects of prasugrel and/or ticagrelor on endothelial function.
With the present trial, the investigators plan to test the effect of clopidogrel, prasugrel and ticagrelor on endothelial function before and up to 4 weeks after coronary artery stenting.
This study will provide important pathophysiologic insight on the relationship between platelet aggregation and endothelial function, two parameters that have been shown to influence patients' prognosis.
Aperçu de l'étude
Statut
Complété
Les conditions
Intervention / Traitement
Type d'étude
Interventionnel
Inscription (Réel)
126
Phase
- Phase 4
Contacts et emplacements
Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.
Lieux d'étude
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Mainz, Allemagne, 55131
- 2 Medical Clinic
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Critères de participation
Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.
Critère d'éligibilité
Âges éligibles pour étudier
18 ans à 75 ans (Adulte, Adulte plus âgé)
Accepte les volontaires sains
Non
Sexes éligibles pour l'étude
Tout
La description
Inclusion Criteria:
- - 18-75 years old consecutive patients undergoing coronary angiography and stenting at the University Medical Centre Mainz
- A coronary lesion (and patient) amenable to treatment with drug eluting stent
- Ability of subject to understand character and individual consequences of clinical trial
- Signed and dated informed consent of the subject must be available before start of any specific trial procedures.
- Negative pregnancy test of women with childbearing potential
Exclusion Criteria:
- Subjects presenting 1 or more of the following criteria will not be enrolled in the trial:
- Patients with elevated (> 5 times upper normal limit) C-reactive protein level prior to stenting
- Patients in whom therapy with long-acting nitrates cannot be suspended prior to endothelial function measurements
- An acute coronary syndrome treated with coronary stenting within the last 4 weeks
- Patients with known inflammatory/infective diseases
- Patients with severe extracardiac diseases limiting life expectancy
- Known heart failure (LV-EF ≤ 40% AND NYHA III-IV)
- PCI or coronary By-Pass surgery within the last 4 weeks, pre-existing ongoing treatment with any of the study treatments.
- History of cerebrovascular events (stroke)
- Known renal dysfunction (serum creatinine ≥ 1.8mg/dl in women, ≥ 2.0mg/dl in men)
- Serum potassium > 5.5mmol/l
- Known hepatic impairment (AST, ALT > 3 times upper limit of normal)
- Changes in the ß-blocker, statin or ACE or angiotensin-receptor blocker inhibitor treatment within the past 2 weeks
- Pregnancy and lactation, inadequate contraception
- Body weight < 60kg
- Active bleeding
- Therapy with CYP3A4 inhibitors (ketoconazole, protease inhibitors, macrolide antibiotics)
- Therapy with anticoagulants: phenprocoumone, warfarin, dabigatran, rivaroxaban
- History of hypersensitivity to any of the investigational medicinal products or to any drug with similar chemical structure or to any excipient present in the pharmaceutical form of the investigational medicinal product.
- Ongoing participation in other clinical trials or within the last 3 months, or ongoing therapy with one of the study medications.
- Medical or psychological condition that would not permit completion of the trial or signing of informed consent.
- Patients with acute ST-elevation myocardial infarction
Plan d'étude
Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Science basique
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Seul
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
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Comparateur actif: Ticagrelor
Ticagrelor 180mg oral loading dose and 90mg b.i.d for 30 days following coronary artery stenting
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All patients will receive a drug eluting stent as clinically indicated.
Ticagrelor 180mg oral loading dose and 90mg b.i.d for 30 days following coronary artery stenting
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Comparateur actif: Clopidogrel
Clopidogrel 600mg loading dose + 75 mg once a day for 30 days following coronary artery stenting.
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All patients will receive a drug eluting stent as clinically indicated.
Clopidogrel 600mg loading dose + 75 mg once a day for 30 days following coronary artery stenting.
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Comparateur actif: Prasugrel
Prasugrel 60mg oral loading dose followed by 10mg once a day for 30 days following coronary artery stenting
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All patients will receive a drug eluting stent as clinically indicated.
Prasugrel 60mg oral loading dose followed by 10mg once a day for 30 days following coronary artery stenting
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Change in FMD
Délai: baseline and 1 month
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The primary endpoint is the change in flow-mediated dilation (FMD) (comparison before treatment versus after treatment and stenting) in the three study groups.
The mean FMD across the three measurements (1 day, 1 week, 1 month) performed after coronary artery stenting will be compared to the FMD value before drug administration and stenting.
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baseline and 1 month
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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FMD 2 hours after loading dose
Délai: baseline and 2 hours after loading dose
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Change in FMD 2 hours after the administration of the study drug
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baseline and 2 hours after loading dose
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L-FMC at 2 hours after the loading dose
Délai: baseline and 2 hours
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change in L-FMC at two hours after the loading dose
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baseline and 2 hours
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L-FMC 1 month after loading dose
Délai: baseline and 1 day after stenting
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change in flow-mediated constriction (L-FMC) (comparison before treatment versus after treatment and stenting) in the three study groups.
The mean L-FMC across the three measurements (1 day, 1 week, 1 month) performed after coronary artery stenting will be compared to the value before drug administration and stenting
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baseline and 1 day after stenting
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Safety and tolerability
Délai: from baseline to 1 month after enrollment
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Number of patients with adverse events.
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from baseline to 1 month after enrollment
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Collaborateurs et enquêteurs
C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.
Parrainer
Les enquêteurs
- Chaise d'étude: Thomas Munzel, MD Prof., University Medical Center Mainz
Publications et liens utiles
La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.
Publications générales
- Schnorbus B, Jurk K, Lackner KJ, Welk C, Munzel T, Gori T. Effects of Clopidogrel, Prasugrel and Ticagrelor on Microvascular Function and Platelet Reactivity in Patients With Acute Coronary Syndrome Undergoing Coronary Artery Stenting. A Randomized, Blinded, Parallel Group Trial. Front Cardiovasc Med. 2021 Dec 13;8:780605. doi: 10.3389/fcvm.2021.780605. eCollection 2021.
- Schnorbus B, Daiber A, Jurk K, Warnke S, Konig J, Krahn U, Lackner K, Munzel T, Gori T. Effects of clopidogrel, prasugrel and ticagrelor on endothelial function, inflammatory and oxidative stress parameters and platelet function in patients undergoing coronary artery stenting for an acute coronary syndrome. A randomised, prospective, controlled study. BMJ Open. 2014 May 6;4(5):e005268. doi: 10.1136/bmjopen-2014-005268.
Dates d'enregistrement des études
Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.
Dates principales de l'étude
Début de l'étude
1 août 2012
Achèvement primaire (Réel)
1 juillet 2016
Achèvement de l'étude (Réel)
1 septembre 2016
Dates d'inscription aux études
Première soumission
4 septembre 2012
Première soumission répondant aux critères de contrôle qualité
3 octobre 2012
Première publication (Estimation)
4 octobre 2012
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Estimation)
7 septembre 2016
Dernière mise à jour soumise répondant aux critères de contrôle qualité
4 septembre 2016
Dernière vérification
1 septembre 2016
Plus d'information
Termes liés à cette étude
Termes MeSH pertinents supplémentaires
- Maladies cardiaques
- Maladies cardiovasculaires
- Maladies vasculaires
- Artériosclérose
- Maladies artérielles occlusives
- Maladie de l'artère coronaire
- Ischémie myocardique
- Maladie coronarienne
- Effets physiologiques des médicaments
- Agents neurotransmetteurs
- Mécanismes moléculaires de l'action pharmacologique
- Inhibiteurs de l'agrégation plaquettaire
- Antagonistes des récepteurs purinergiques P2Y
- Antagonistes des récepteurs purinergiques P2
- Antagonistes purinergiques
- Agents purinergiques
- Ticagrélor
- Clopidogrel
- Chlorhydrate de prasugrel
Autres numéros d'identification d'étude
- CTH-C1
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