Endothelium, Stenting, and Antiplatelet Therapy (EST) - Clopidogrel, Prasugrel, Ticagrelor Study (EST)
4 september 2016 bijgewerkt door: 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.
Studie Overzicht
Toestand
Voltooid
Conditie
Interventie / Behandeling
Studietype
Ingrijpend
Inschrijving (Werkelijk)
126
Fase
- Fase 4
Contacten en locaties
In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.
Studie Locaties
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Mainz, Duitsland, 55131
- 2 Medical Clinic
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Deelname Criteria
Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
18 jaar tot 75 jaar (Volwassen, Oudere volwassene)
Accepteert gezonde vrijwilligers
Nee
Geslachten die in aanmerking komen voor studie
Allemaal
Beschrijving
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
Studie plan
Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Fundamentele wetenschap
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Enkel
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
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Actieve vergelijker: 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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Actieve vergelijker: 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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Actieve vergelijker: 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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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Change in FMD
Tijdsspanne: 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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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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FMD 2 hours after loading dose
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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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Medewerkers en onderzoekers
Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.
Onderzoekers
- Studie stoel: Thomas Munzel, MD Prof., University Medical Center Mainz
Publicaties en nuttige links
De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.
Algemene publicaties
- 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.
Studie record data
Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.
Bestudeer belangrijke data
Studie start
1 augustus 2012
Primaire voltooiing (Werkelijk)
1 juli 2016
Studie voltooiing (Werkelijk)
1 september 2016
Studieregistratiedata
Eerst ingediend
4 september 2012
Eerst ingediend dat voldeed aan de QC-criteria
3 oktober 2012
Eerst geplaatst (Schatting)
4 oktober 2012
Updates van studierecords
Laatste update geplaatst (Schatting)
7 september 2016
Laatste update ingediend die voldeed aan QC-criteria
4 september 2016
Laatst geverifieerd
1 september 2016
Meer informatie
Termen gerelateerd aan deze studie
Aanvullende relevante MeSH-voorwaarden
- Hartziekten
- Hart-en vaatziekten
- Vaatziekten
- Arteriosclerose
- Arteriële occlusieve ziekten
- Coronaire hartziekte
- Myocardiale ischemie
- Hart-en vaatziekte
- Fysiologische effecten van medicijnen
- Neurotransmitter agenten
- Moleculaire mechanismen van farmacologische werking
- Bloedplaatjesaggregatieremmers
- Purinerge P2Y-receptorantagonisten
- Purinerge P2-receptorantagonisten
- Purinerge antagonisten
- Purinerge middelen
- Ticagrelor
- Clopidogrel
- Prasugrelhydrochloride
Andere studie-ID-nummers
- CTH-C1
Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .