- ICH GCP
- Register voor klinische proeven in de VS.
- Klinische proef NCT01724957
FFR vs. icECG in Coronary Bifurcations (FIESTA)
Fractional Flow Reserve Versus Intracoronary ECG for Detection of Post Stenting Ischemia in Side Branch Territory in coronAry Bifurcation Lesions
Studie Overzicht
Toestand
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
The coronary bifurcation lesions pose a therapeutic problem with high rates of periprocedural complications, higher rates of in-stent restenosis and stent thrombosis. These are lesions where stenting is not superior in comparison to balloon angioplasty in regard to side branch. It was demonstrated many times, in literature and in daily practice, that angiographically high grade ostial side branch stenosis is not flow limiting and do not cause ischemia, therefore do not require treatment. From the other side, our own data with MRI before and after bifurcation PCI demonstrated that occurrence of angiographic stenosis more than 70% in diameter is associated with periprocedural myonecrosis in the region of side branch. This fact puts a very important question about the mechanisms of this myonecrosis. If the jailed side branch has no significant flow limiting stenosis, but there is some degree of residual ischemia, which after some period of persistence could lead to myonecrosis, will mean that more aggressive treatment of ostial stenosis is needed. It is interesting that the strategy of treatment is very important, because techniques with second stent implantation (with primary purpose to limit SB ischemia) are associated with higher grade of troponin increase. Of course this is association and not causality, despite that in randomized study (NORDIC I) it was confirmed also.
It is without explanation the fact of rare occurrence of significant (flow limiting, FFR <.75) stenosis appearance (less than 40% in side branches with ostial stenosis more than 75%) and almost 50% periprocedural myonecrosis detected in the side branch areas. One working hypothesis is that stent implantation and related episode of ischemia induces prolonged vasospasm, resulting in prolonged ischemia. Thus, the ostial stenosis could be non-significant as estimated and registered by FFR, but on microcirculatory lever ischemia could persist is small areas for which available flow is not sufficient despite that global regional flow is deemed sufficient. It is also possible that those patients have not enough recruitable collaterals. It is also possible that both factors act together.
Although FFR is useful for assessing the degree of ischemia caused by a coronary lesion, it cannot give information as to whether this ischemia may be clinically significant or not, i.e. whether the ischemia affects a large territory. Therefore, it can be implicated that FFR may not be useful in predicting clinically meaningful ischemia in a specific side branch vessel.
The intracoronary electrocardiography (i.c. ECG) is a very sensitive method for ischemia detection. The i.c. ECG reacts earlier on ischemia; the changes are much more prominent and easy to register. The wire tip could be positioned directly in different regions and thus to "map" regional ischemia. In most of the studies and from our own observations became evident that when surface ECG do not react the i.c. ECG demonstrates significant changes in ST-segment and QRS complex. Moreover, the registration of i.c. ECG is very cheap and needs only an adapter connecting coronary wire end and ECG. An i.c. ECG also can differentiate residual ischemic changes in distal main vessel and side branch as sources of prolonged ischemia, respectively - source of periprocedural myonecrosis.
The objective of this study is to evaluate concordance between icECG findings and FFR findings after stenting main vessel.
Studietype
Inschrijving (Verwacht)
Contacten en locaties
Studie Locaties
-
-
-
Sofia, Bulgarije, 1309
- Werving
- National Heart Hospital
-
Contact:
- Dobrin Vassilev, MD, PhD
- Telefoonnummer: 00359886846550
- E-mail: dobrinv@gmail.com
-
-
-
-
Indiana
-
Indianapolis, Indiana, Verenigde Staten, IN 46202
- Actief, niet wervend
- Indiana-Purdue University
-
-
Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Bemonsteringsmethode
Studie Bevolking
- Significant, >50% diameter stenosis artery scheduled for stent insertion at the main vessel (Medina types: 1xx, x1x, 11x);
- Side branch vessel at least 2.0mm
Beschrijving
Inclusion Criteria:
- Subject at least 18 years of age.
- Subject able to verbally confirm understandings of risks, benefits of receiving PCI for true bifurcation lesions, and he/she or his/her legally authorized representative provides written informed consent prior to any study related procedure.
- Target main branch lesion(s) located in a native coronary artery with diameter of ≥ 2.5 mm and ≤ 4.5 mm. Target side branch lesion(s) located in a native coronary artery with diameter of ≥ 2.0 mm.
- Target lesion(s) amenable for PCI with balloon angioplasty of the side branch.
Exclusion Criteria:
- Subjects with significant ST-T change (≥ 1mm).
- Non-cardiac co-morbid conditions are present with life expectancy <1 year or that may result in protocol non-compliance (per site investigator's medical judgment).
- Subjects who refuse to give informed consent.
- Subjects with the following angiographic characteristics: left main coronary artery stenosis, total occlusion before occurrence of SB, lesion of interest located at infarct-related artery.
- Subjects with LVEF < 30%.
- Subjects with moderate or severe degree valvular heart disease or primary cardiomyopathy.
- LBBB, RBBB, atrial fibrillation/flutter with no identifiable isoelectric line.
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
Cohorten en interventies
Groep / Cohort |
Interventie / Behandeling |
---|---|
Patients with coronary bifurcation lesions
Only one group will be studied.
The patient will be a slef-reference.
|
Recording of icECG from the tip of PCI guidewire.
The wire end is connected through alligator clips to V-lead from surface ECG
|
Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
---|---|---|
Side branch region ischemia duration
Tijdsspanne: Percutaneous coronary intervention procedure time (up to 4h)
|
FFR<0.80 at the SB ostium after stenting main vessel in coronary bifurcation lesion; icECG ST-segment elevation >2.0mm; T-wave inversion >3mm; ST-segment depression >2mm, not observed at the beginning of procedure
|
Percutaneous coronary intervention procedure time (up to 4h)
|
Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
---|---|---|
Doel laesie revascularisatie
Tijdsspanne: 12 maanden
|
Elke revascularisatie op het grondgebied van een eerder geïmplanteerde stent.
|
12 maanden
|
Nieuwe symptomen van angina pectoris of hartfalen
Tijdsspanne: 12 maanden
|
Nieuwe symptomen van angina pectoris van ten minste CCS klasse II; Nieuw optredende dyspnoe bij inspanning of in rust
|
12 maanden
|
Number of patients not alive
Tijdsspanne: 12 month
|
12 month
|
|
Myocardial infarction after hospital discharge
Tijdsspanne: 12 months
|
MI according to universal definition of MI - CK-MB > 2xULN +/- symptoms +/- surface ECG changes in at least 2 leads
|
12 months
|
Andere uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
---|---|---|
Periprocedural myonecrosis - extent of post PCI enzyme elevation
Tijdsspanne: 48h
|
Troponin I elevation 1-3; 3-5; >5 x ULN Creatin phospho kinase MB fraction elevation 1-3; 3-5; >5 x ULN
|
48h
|
Medewerkers en onderzoekers
Studie record data
Bestudeer belangrijke data
Studie start
Primaire voltooiing (Werkelijk)
Studie voltooiing (Verwacht)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Schatting)
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
- 20120109-05
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 .
Klinische onderzoeken op Coronaire hartziekte
-
Lawson Health Research InstituteVoltooidArteriosclerose van Arterial Coronary Artery Bypass GraftCanada
-
Deutsches Herzzentrum MuenchenVoltooidArteriosclerose van Arterial Coronary Artery Bypass GraftDuitsland
-
University Hospital, AngersWervingPopliteale slagaderbeknellingFrankrijk
-
University Hospital, AngersVoltooidPoplitea Entrapment SyndroomFrankrijk
-
Stanford UniversityIngetrokkenPoplitea Artery Entrapment Syndroom | Functioneel beknellingssyndroom van de arteria popliteaVerenigde Staten
-
University Hospital, Strasbourg, FranceWervingEpistaxis, Anterior Ethmoid ArteryFrankrijk
-
Resicardunion nationale de formation et d'evaluation en medecine cardio-vasculaireVoltooidHartfalen | Acute kransslagader syndroom | Coronaire Bypass Graft Stenose van Native Artery GraftFrankrijk
Klinische onderzoeken op Intracoronary ECG
-
Murdoch Childrens Research InstituteWervingNeoplasmata | HartritmestoornissenAustralië
-
The Leeds Teaching Hospitals NHS TrustLeeds and York Partnership NHS Foundation TrustOnbekendEen evaluatie van de veiligheid en het klinische nut van draagbare ECG-technologie in de psychiatrieHart-en vaatziekten | Dementie | Psychische stoornisVerenigd Koninkrijk
-
Charite University, Berlin, GermanyBayer Healthcare Pharmaceuticals, Inc./Bayer Schering PharmaVoltooidHartinfarct | BoezemfibrillerenDuitsland
-
University Hospital, BordeauxGrant Agreement ERC n°715093; University of Bordeaux - mission UB-C19VoltooidCOVID-19 | VirusziekteFrankrijk
-
Samsung Medical CenterVoltooidPijn op de borst | ElektrocardiografieKorea, republiek van
-
Population Health Research InstituteHeart and Stroke Foundation of Canada; Canadian Cardiovascular SocietyVoltooidHartfalen | BoezemfibrillerenCanada
-
Alaska Blind Child DiscoveryWerving
-
TriVirum, Inc.Actief, niet wervendBoezemfibrilleren | Afib | ECGVerenigde Staten
-
Wonju Severance Christian HospitalWervingAritmieKorea, republiek van
-
Apple Inc.Iqvia Pty LtdVoltooid