- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT00922675
Postconditioning in ST-elevation Myocardial Infarction (POSTEMI)
Postconditioning in ST-elevation Myocardial Infarction Treated With Primary PCI
Study objectives: To assess the effects of postconditioning on infarct size in patients with ST-elevation infarction referred to PCI.
Study design: Prospective, randomized, open-label study with blinded endpoint evaluation. Included patients will be randomly allocated to postconditioning or control. Patients with symptoms of acute myocardial infarction of less than 6 hours duration fulfilling ECG criteria for primary PCI are eligible. PCI follow established routines. In postconditioning patients, additional, short (1 min), intermittent balloon occlusions will be applied after initial opening of infarct related artery. After this intervention, PCI proceeds routinely with stent implantation. In the control group, stent implantation after initial opening proceeds as usual. Primary endpoint is final infarct size, determined by MRI after 4 months. 260 patients will be included. Follow-up is 1 year. Inclusion period: 18 - 24 months.
Clinical implications: Reperfusion therapy, administered as early as possible after start of symptoms, has improved the prognosis in acute ST-elevation myocardial infarction. Still, however, many patients suffer large infarctions, subsequently with an increased risk of heart failure, arrhythmias, and death. In pilot studies, mechanical postconditioning has been shown to reduce infarct size and thus potentially improve prognosis. However, the effect of postconditioning must be confirmed in larger clinical trials before implemented in routine treatment.
Studieoversikt
Status
Forhold
Intervensjon / Behandling
Studietype
Registrering (Faktiske)
Fase
- Ikke aktuelt
Kontakter og plasseringer
Studiesteder
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Oslo, Norge, N-0407
- Dept. of Cardiology, Oslo Univ. Hosp. Ulleval
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Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
Beskrivelse
Inclusion Criteria:
- acute symptoms consistent with an acute myocardial infarction of less than 6 hours duration
- an occluded infarct related artery must be demonstrated (TIMI-flow 0-1)
Exclusion Criteria:
- Prior myocardial infarction
- Demonstration of collaterals to the infarcted area
- TIMI-flow >1 before intervention or TIMI-flow <2 after initial balloon inflation
- Demonstration of a distal occlusion
- Patients given thrombolytic treatment
- Patients in cardiogenic shock
- Any contraindication to MRI (magnetic resonance imaging)
- Unwillingness to participate
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Enkelt
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
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Eksperimentell: Postconditioning
Active arm:Postconditioning protocol before routine PCI/stenting of an occluded coronary artery
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After opening of IRA and establishment of TIMI-flow grade 2 or 3, the control group continues the procedure with stenting.
In the postconditioning group 4 additional balloon inflations separated by 1 minute reperfusion are given, starting after 1 minute of reperfusion.
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Annen: Control
Control arm: Routine PCI/stenting of an occluded coronary artery without postconditioning
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After opening of IRA and establishment of TIMI-flow grade 2 or 3, the control group continues the procedure with stenting.
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Hva måler studien?
Primære resultatmål
Resultatmål |
Tidsramme |
---|---|
Infarct size, assessed by MRI
Tidsramme: 4 months
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4 months
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Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
Myocardial blushing grade
Tidsramme: assessed at the end of PCI procedure
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assessed at the end of PCI procedure
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ST-resolution in ECG
Tidsramme: Assessed after 1 hour
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Assessed after 1 hour
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Troponin-T and CK-MB
Tidsramme: peak release values
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peak release values
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Echocardiographic evaluation of left ventricular function including speckle-tracking measurement.
Tidsramme: assessed at baseline, 4 months and1 year
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Assesment of LV function.
Comparison with CMR in the whole study population and between treatment groups.
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assessed at baseline, 4 months and1 year
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Incidence of treated arrhythmias and heart failure during initial hospitalization Incidence of death, non-fatal myocardial infarction, unstable angina, heart failure, and cerebrovascular disease
Tidsramme: 1-year follow up.
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1-year follow up.
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Myocardial salvage
Tidsramme: Baseline to 4 months
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Myocardial salvage defined as (area at risk-final infarct size)/area at risk.
Area at risk measured by CMR at baseline and final infarct size by CMR at 4 months.
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Baseline to 4 months
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Samarbeidspartnere og etterforskere
Sponsor
Etterforskere
- Studiestol: Jan Eritsland, MD, PhD, Oslo Univ.Hosp. Ulleval
Publikasjoner og nyttige lenker
Generelle publikasjoner
- Tollefsen IM, Shetelig C, Seljeflot I, Eritsland J, Hoffmann P, Andersen GO. High levels of interleukin-6 are associated with final infarct size and adverse clinical events in patients with STEMI. Open Heart. 2021 Dec;8(2):e001869. doi: 10.1136/openhrt-2021-001869.
- Limalanathan S, Andersen GO, Klow NE, Abdelnoor M, Hoffmann P, Eritsland J. Effect of ischemic postconditioning on infarct size in patients with ST-elevation myocardial infarction treated by primary PCI results of the POSTEMI (POstconditioning in ST-Elevation Myocardial Infarction) randomized trial. J Am Heart Assoc. 2014 Apr 23;3(2):e000679. doi: 10.1161/JAHA.113.000679.
Studierekorddatoer
Studer hoveddatoer
Studiestart
Primær fullføring (Faktiske)
Studiet fullført (Faktiske)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Anslag)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Anslag)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Nøkkelord
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- Po 1506
Plan for individuelle deltakerdata (IPD)
Planlegger du å dele individuelle deltakerdata (IPD)?
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