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Spontaneous Coronary Artery Dissection - AntipLatelet Therapy Intensity in Guided coNservative Management (SCAD-ALIGN) Trial (SCAD-ALIGN)

28 juni 2026 bijgewerkt door: Universitätsklinikum Hamburg-Eppendorf

Spontaneous Coronary Artery Dissection - Antiplatelet Therapy Intensity in Guided Conservative Management (SCAD-ALIGN) Trial

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome in which blood flow to the heart muscle is reduced or interrupted. It predominantly affects women between 30 and 55 years of age and typically occurs in the absence of atherosclerosis. For many years, SCAD remained underdiagnosed and has only recently been more systematically recognised. The SCAD-ALIGN trial will be the first randomised study to systematically compare two antiplatelet treatment strategies in patients with SCAD.

SCAD is usually not associated with significant atherosclerosis or the classic vessel occlusion caused by a blood clot. Instead, bleeding occurs within the wall of a coronary artery, causing the vessel layers to separate and thereby impairing or completely obstructing blood flow. Patients develop symptoms of acute myocardial infarction, such as chest pain, shortness of breath, or nausea. A characteristic feature is that these symptoms often occur in individuals without a prior history or risk of heart disease.

Platelets play a crucial role in blood clotting but can also accumulate inside blood vessels and further impair flow. Antiplatelet medications are used to prevent this. In current clinical practice, SCAD patients are often treated according to general guidelines for acute coronary syndrome, which typically include two different antiplatelet therapies, a strategy developed and tested in older patients with proven atherosclerosis.

The SCAD-ALIGN trial is based on a fundamental difference between SCAD and classic heart attacks. In typical heart attacks, a blood clot usually blocks a vessel, and after the implantation of a vascular support device ("stent"), intensive antiplatelet therapy is used to prevent further clot formation. In SCAD, however, the underlying problem is a tear or bleeding within the vessel wall. In this situation, intensive antiplatelet therapy could delay the resolution of the bleeding or even worsen it, thereby adversely affecting the course of the disease. The study will therefore investigate whether a less intensive treatment strategy may be more beneficial in these patients.

The SCAD-ALIGN trial compares two treatment strategies: moderate antiplatelet therapy with a single medication for three months versus more intensive therapy with two agents for three months, followed by nine months of treatment with a single medication. The primary endpoint is a composite of recurrent myocardial ischemia, recurrent SCAD, myocardial infarction, the need for revascularization, and death.

The SCAD-ALIGN trial is part of the Multinational Clinical Trials Initiative of the Global Cardiovascular Research Funders Forum (GCRFF). The study is designed as an international, multicentre, randomised, open-label clinical trial. Because SCAD is a rare condition, close collaboration across national borders is essential. The results are expected to make an important contribution to the development of evidence-based treatment recommendations for SCAD, improve care and quality of life for patients worldwide.

Studie Overzicht

Toestand

Nog niet aan het werven

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

Spontaneous Coronary Artery Dissection (SCAD) is an important cause of acute coronary syndromes (ACS), predominantly in younger women. Evidence to guide optimal antiplatelet therapy is limited. Although dual antiplatelet therapy (DAPT) is commonly prescribed, observational studies have linked DAPT to higher rates of adverse cardiovascular events in conservatively managed SCAD. The SCAD-ALIGN trial is an international, prospective, randomized, open-label, group-sequential adaptative, blinded endpoint-adjudicated with two-parallel groups, multicenter trial comparing an intensive APT strategy versus a moderate APT strategy in patients with ACS due to SCAD who are treated conservatively, i.e., without revascularization. The SCAD-ALIGN study will define the benefit-risk balance of these strategies, inform international guideline committees, and clarify optimal treatment strategies. To demonstrate the superiority of a moderate intensity APT strategy compared to an intensive treatment regimen in patients presenting with an ACS caused by SCAD with planned conservative management with regard to major adverse cardiovascular events (MACE), a composite endpoint consisting of all-cause mortali-ty, myocardial infarction, recurrent SCAD, unplanned coronary revascularization, ischemic stroke, or transient ischemic attack 12 months after randomization was chosen.

Studietype

Ingrijpend

Inschrijving (Geschat)

3518

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.

Studiecontact

Studie Contact Back-up

Studie Locaties

  • Canada
    • British Columbia
      • Vancouver, British Columbia, Canada, V5Z 1M9
        • Division of Cardiology, Vancouver General Hospital, University of British Columbia
        • Contact:
  • Duitsland
    • Free and Hanseatic City of Hamburg
      • Hamburg, Free and Hanseatic City of Hamburg, Duitsland, 20246
        • University Medical Center Hamburg-Eppendorf
        • Contact:
  • Nederland
      • Nieuwegein, Nederland, 3435 CM
        • Division of Cardiology, St. Antonius Hospital
        • Contact:
  • Verenigd Koninkrijk
      • Leicester, Verenigd Koninkrijk, LE1 5WW
        • University Hospitals of Leicester NHS Trust
        • Contact:
  • Zweden
      • Linköping, Zweden, SE-581 83
        • Department of Cardiology and Department of Medical and Health Sciences, Linköping University
        • Contact:

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

  • Volwassen
  • Oudere volwassene

Accepteert gezonde vrijwilligers

Nee

Beschrijving

Inclusion Criteria:

  1. Age ≥18 years.
  2. Presentation with an Acute Coronary Syndrome.
  3. Suspected SCAD on coronary angiography (determined by the local investigator).
  4. Planned conservative treatment of SCAD.
  5. Intensive as well as moderate treatment of SCAD is possible.
  6. Ability to understand the patient information and to personally sign and date the informed consent to participate in the study, before completing any study-related procedures.
  7. The patient is cooperative and available for the entire study.
  8. Written and informed consent.
  9. For women of childbearing potential: Patient is willing to use adequate contraceptive precautions during the study (until 12 Month FU)

Exclusion Criteria:

  1. Hypersensitivity to the study medication.
  2. Any indication for oral anticoagulation.
  3. Any indication for APT (including thienopyridines, non-thienopyridines, ASA and other anti-thrombotic agents) other than SCAD.
  4. Cardiogenic shock at the time of screening.
  5. Coronary artery disease (CAD) requiring secondary preventive therapy with APT.
  6. Life threatening bleeding (BARC type ≥3) at the time of screening.
  7. Active bleeding, such as peptic ulcer, tumor bleeding or intracranial hemor-rhage at the time of screening.
  8. History of major bleeding, BARC class ≥3 within 3 months before study in-clusion.
  9. Known bleeding diathesis.
  10. Known coagulopathy or refusal of blood transfusion.
  11. Planned surgery or intervention at high bleeding risk during the study period.
  12. Co-administration of contraindicated medications as follows: other P2Y12 inhibitors (prasugrel or ticagrelor); anticoagulants (warfarin, new oral antico-agulants, or chronic therapy with subcutaneous anticoagulants); cytochrome P450 2C19 inhibitors (fluoxetine, moclobemid or voriconazole); probenecid; high dose of methotrexate (≥15 mg/week); lithium.
  13. Known pregnancy or lactation.
  14. Current participation in another clinical trial with drugs or medicinal products.

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: Behandeling
  • Toewijzing: Gerandomiseerd
  • Interventioneel model: Parallelle opdracht
  • Masker: Enkel

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Experimenteel: moderate APT
moderate APT therapy, defined as 3 months ASA followed by cessation of APT
Geneesmiddel: Acetylsalicylic acid ASA
3 months ASA monotherapy, dose accoring to international guidelines and local Standard of Care
Actieve vergelijker: intensive APT
intensive APT therapy, defined as 3 months DAPT (ASA + clopidogrel), followed by 9 months of clopidogrel monotherapy
Geneesmiddel: ASA plus Clopidogrel
3 months ASA + clopidgrel DAPT, followed by 9 months of clopidogrel monotherapy, doses accoring to international guidelines and local Standard of Care

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
MACE (Major Adverse Cardiovascular Events) with all-cause-mortality
Tijdsspanne: 12 months follow-up
MACE as a composite of all-cause mortality, myocardial infarction, recurrent SCAD, unplanned coronary revascularization, ischemic stroke, or transient is-chemic attack
12 months follow-up

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
First secondary endpoint: MACE (Major Adverse Cardiovascular Events) with cardiovascular mortality
Tijdsspanne: 12 months follow-up
Composite endpoint consisting of cardiovascular mortality, myocardial infarction, recurrent SCAD, unplanned coronary revascularization, ischemic stroke, or transient ischemic attack
12 months follow-up
second secondary endpdoint: NACE (Net adverse clinical events)
Tijdsspanne: 12 months follow-up
composite of cardiovascular mortality, myocardial infarction, recurrent SCAD, unplanned coronary revascularization, ischemic stroke or transient ischemic attack and Bleeding aca-demia research consortium (BARC) bleeding types 3 or 5
12 months follow-up
MACE
Tijdsspanne: 3 Months follow-up
composite endpoint consisting of cardiovascular mortality, myocardial infarction, recurrent SCAD, unplanned coronary revascularization, ischemic stroke, or transient ischemic attack
3 Months follow-up
all-cause mortality
Tijdsspanne: 3 months FU
3 months FU
all-cause mortality
Tijdsspanne: 12 months FU
12 months FU
cardiovascular mortality
Tijdsspanne: 3 months FU
3 months FU
cardiovascular mortality
Tijdsspanne: 12 months FU
12 months FU
myocardial infarction
Tijdsspanne: 3 months FU
3 months FU
myocardial infarction
Tijdsspanne: 12 months FU
12 months FU
recurrent SCAD
Tijdsspanne: 3 months FU
3 months FU
recurrent SCAD
Tijdsspanne: 12 months FU
12 months FU
unplanned coronary revascularization
Tijdsspanne: 3 months FU
3 months FU
unplanned coronary revascularization
Tijdsspanne: 12 months FU
12 months FU
ischemic stroke
Tijdsspanne: 3 months FU
3 months FU
ischemic stroke
Tijdsspanne: 12 months FU
12 months FU
transient ischemic attack
Tijdsspanne: 3 months FU
3 months FU
transient ischemic attack
Tijdsspanne: 12 months FU
12 months FU
NACE
Tijdsspanne: 3 months FU
composite of cardiovascular mortality, myocardial infarction, recurrent SCAD, unplanned coronary revascularization, ischemic stroke or transient ischemic attack and BARC bleeding types 3 or 5
3 months FU
BARC bleeding type 1, 2, 3 or 5
Tijdsspanne: 3 months FU
3 months FU
BARC bleeding type 1, 2, 3 or 5
Tijdsspanne: 12 months FU
12 months FU
Menorrhagia associated quality of life
Tijdsspanne: 3 months FU
assessed with Menorrhagia multi-attribute scale (MMAS), consisting of 6 dimensions with 4-level Likert scale for responses
3 months FU
Menorrhagia associated quality of life
Tijdsspanne: 12 months FU
assessed with Menorrhagia multi-attribute scale (MMAS), consisting of 6 dimensions with 4-level Likert scale for responses
12 months FU
MACE
Tijdsspanne: 3 Months follow-up
composite endpoint consisting of all-cause mortality, myocardial infarction, recurrent SCAD, unplanned coronary revascularization, ischemic stroke, or transient ischemic attack
3 Months follow-up
Health-related Quality of Life
Tijdsspanne: 3 months FU
assessed with EQ5D-5L questionnaire, consisting of 5 domains with 5-level Likert scale and a visual analogue self-rating scale (VAS) from 0 (worst) to 100 (best)
3 months FU
Health-related Quality of Life
Tijdsspanne: 12 months FU
assessed with EQ5D-5L questionnaire, consisting of 5 domains with 5-level Likert scale and a visual analogue self-rating scale (VAS) from 0 (worst) to 100 (best)
12 months FU
Patient Health Questionnaire PHQ-8
Tijdsspanne: 3 months FU
self-administered version of the Primary Care Evaluation of Mental Disorders diagnostic Instrument for common mental disorders. The PHQ-8 is the depression module, which scores each of the 8 diagnostic criteria for major depression in Diagnostic and Statistical Manual Fourth Edition using a 4-level Likert scale
3 months FU
Patient Health Questionnaire PHQ-8
Tijdsspanne: 12 months FU
self-administered version of the Primary Care Evaluation of Mental Disorders diagnostic Instrument for common mental disorders. The PHQ-8 is the depression module, which scores each of the 8 diagnostic criteria for major depression in Diagnostic and Statistical Manual Fourth Edition using a 4-level Likert scale
12 months FU
Generalized Anxiety Disorder (GAD-7) questionnaire
Tijdsspanne: 3 months FU
screening tool to identify probable cases of GAD and to assess symptom severity. 7 items and 4-level Likert-scale
3 months FU
Generalized Anxiety Disorder (GAD-7) questionnaire
Tijdsspanne: 12 months FU
screening tool to identify probable cases of GAD and to assess symptom severity. 7 items and 4-level Likert-scale
12 months FU

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

Universitätsklinikum Hamburg-Eppendorf

Medewerkers

Gesellschaft für Therapieforschung mbH
Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK)
National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
Cardio-CARE AG, Davos

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 (Geschat)

1 maart 2027

Primaire voltooiing (Geschat)

28 februari 2033

Studie voltooiing (Geschat)

28 februari 2033

Studieregistratiedata

Eerst ingediend

2 juni 2026

Eerst ingediend dat voldeed aan de QC-criteria

28 juni 2026

Eerst geplaatst (Werkelijk)

6 juli 2026

Updates van studierecords

Laatste update geplaatst (Werkelijk)

6 juli 2026

Laatste update ingediend die voldeed aan QC-criteria

28 juni 2026

Laatst geverifieerd

1 mei 2026

Meer informatie

Termen gerelateerd aan deze studie

Trefwoorden

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • SCAD-ALIGN-DZHK31
  • 2025-523985-26-00 (Ctis)

Plan Individuele Deelnemersgegevens (IPD)

Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?

ONBESLIST

Beschrijving IPD-plan

to be determined as global study with various stakeholders and country-specific requirements.

Informatie over medicijnen en apparaten, studiedocumenten

Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

Nee

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

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 .

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