Assessment of Revascularization Versus Conservative Treatment in Heart Transplant Patients for a Clinical Event Reduction (ARCHER)
Assessment of Revascularization Versus Conservative Treatment in Heart Transplant Patients for a Clinical Event Reduction: THE ARCHER TRIAL
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
The hypothesis of the study is the superiority of the interventional management over medical therapy alone in preventing the occurrence of the primary endpoint of the study assessed 1 year after randomization.
Objectives: To demonstrate the superiority of the interventional management on top of optimal medical therapy over optimal medical therapy alone in preventing the occurrence of the primary endpoint of the study assessed 1 year after randomization
Design : Multicenter, prospective randomized 1 :1, open-label blinded endpoint study
Target population : Heart transplant recipients, aged ≥18 years, without coronary artery disease-related symptoms, with angiographically significant coronary artery stenoses (≥50% anatomically adequate for a revascularization by coronary angioplasty with stent implantation, with no contraindication to dual antiplatelet therapy associating aspirin and a P2Y12 inhibitorfor a duration of 12 monthsand with ni grade IA ACC/AHA indication for revascularization
Inclusion period: 12 months (may be extended based on the inclusion rythme)
Maximum duration of participation for patients : 13 months
Total duration of the study : 37 months
Primary endpoint : The composit of death, myocardial infarction, retransplantation, implantation of transitory or definitve ventricular assist devices, new or worsening heart failure, graft failure and/or a decrease of left ventricular ejection fraction of at least 25% compared to baseline.The occurrence of any event qualifying for the primary endpoint will be assessed by a Cox survival analysis stratified on center.The primary endpoint will be assessed 12 months after randomization.
Secondary endpoints : Any of the individual events defining the primary outcome at 1 year
Number of patients to be included and power calculation : 80 patients per group. A 1 year primary endpoint rate of 30% in the active and 50% in with an inclusion period of 24 months and alpha=5% warants a 90% power using a cox model.
Type d'étude
Inscription (Réel)
Phase
- Phase 3
Contacts et emplacements
Lieux d'étude
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Paris, France, 75013
- Pitié Salpetriere university Hospital - Cardiology
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria:
- Patients ≥ 18 years old
- Heart transplant recipient
- Stable clinical situation
- One or several non-critical coronary stenoses (≥ 50% et ≤ 75% visually or QCA-assessed diameter stenosis) considered as adequate for coronary stenting by the operator
- Left ventricular ejection fraction ≥ 40%
- Informed consentement signed by the patient
Exclusion Criteria:
- Acute coronary syndrome
- In-stent restenosis
- Proof of an extensive myocardial ischemia (≥ 7/17 segments ASE model)
- Coronary stenosis considered as critical by the operators with slow flow
ACC/AHA Class IA indication for revascularization :
- vessel disease with left ventricular dysfunction
- Left main stenosis
- Severe proximal LAD stenosis
- Contra-indication to dual antiplatelet therapy
- Decompensated heart failure at the time of randomization
- Pregnant or breast-feeding women- Patients participating to another clinical research within 30 days before randomization- life expectancy < 1 y
- Patients unable to observe strict medical therapy and follow-up within 1 year after randomization
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
|
Expérimental: 1: Coronary stent+optimal medical therapy
Coronary stent on top of optimal medical therapy
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Coronary revascularization
Autres noms:
Dual antiplatelet therapy: aspirin and a P2Y12 inhibitor as indicated
Autres noms:
|
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Comparateur actif: 2: Optimal medical therapy
Optimal medical therapy
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Dual antiplatelet therapy: aspirin and a P2Y12 inhibitor as indicated
Autres noms:
|
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
The composit of death, myocardial infarction, retransplantation, implantation of transitory or definitive ventricular assist devices, new or worsening heart failure, graft failure and/or a decrease of left ventricular ejection fraction of at least 25%
Délai: at 1 year
|
The composit of death, myocardial infarction, retransplantation, implantation of transitory or definitive ventricular assist devices, new or worsening heart failure, graft failure and/or a decrease of left ventricular ejection fraction of at least 25% at 1 year
|
at 1 year
|
Mesures de résultats secondaires
Mesure des résultats |
Délai |
|---|---|
|
Death at 1 year
Délai: at 1 year
|
at 1 year
|
|
myocardial infarction at 1 year
Délai: at 1 year
|
at 1 year
|
|
Retransplantation at 1 year
Délai: at 1 year
|
at 1 year
|
|
implantation of transitory or definitive ventricular assist devices at 1 year
Délai: at 1 year
|
at 1 year
|
|
new or worsening heart failure at 1 year
Délai: at 1 year
|
at 1 year
|
|
graft failure and/or a decrease of left ventricular ejection fraction of at least 25% at 1 year compared to baseline
Délai: at 1 year
|
at 1 year
|
Collaborateurs et enquêteurs
Parrainer
Les enquêteurs
- Directeur d'études: Farzin BEYGUI, MD, PhD, Assistance Publique - Hôpitaux de Paris
- Chercheur principal: Pascal LEPRINCE, MD, PhD, Assistance Publique - Hôpitaux de Paris
- Chercheur principal: Saida VARNOUS, MD, Assistance Publique - Hôpitaux de Paris
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude
Achèvement primaire (Réel)
Achèvement de l'étude (Réel)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Estimation)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Estimation)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Autres numéros d'identification d'étude
- P081262
- 2010-A01516-33 (Autre identifiant: IDRCB)
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