Optimal Timing of Staged Complete Revascularization in STEMI With Multivessel Disease (OPTION-STEMI2)
13 de agosto de 2026 atualizado por: Min Chul Kim, Chonnam National University Hospital
OPtimal TIming of Staged Complete RevascularizatiON in ST-Segment Elevation Myocardial Infarction With Multivessel Disease: The OPTION-STEMI2 Trial
This prospective, multicenter, open-label, superiority trial will enroll patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease.
Following successful percutaneous coronary intervention (PCI) of the infarct-related artery (IRA), patients who meet the eligibility criteria will be randomized in a 1:1 ratio to either in-hospital staged complete revascularization with PCI of non-IRA lesions performed on a separate day during hospitalization, at least 48 hours after PCI of the IRA, or out-of-hospital staged complete revascularization with PCI of non-IRA lesions performed after discharge between 15 and 45 days of randomization.
In both groups, non-IRA lesions with 50-69% stenosis will be evaluated using FFR.
Visão geral do estudo
Status
Ainda não está recrutando
Condições
Descrição detalhada
- Study Objectives: To determine the optimal timing of staged complete revascularization guided by fractional flow reserve (FFR) (in-hospital staged complete revascularization vs. out-of-hospital staged complete revascularization) in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease.
- Study Background: Approximately half of patients with STEMI have multivessel coronary artery disease, which is associated with worse clinical outcomes than single vessel disease. Complete revascularization has become the standard interventional strategy for the management of these patients. Regarding the timing of complete revascularization, two recent randomized clinical trials demonstrated that immediate complete revascularization was non-inferior to staged complete revascularization in patients with STEMI. In this context, the 2023 European guidelines give a class IA recommendation for complete revascularization, either during the index procedure or within 45 days. The 2025 American guidelines recommend immediate complete revascularization with a class IIb recommendation for hemodynamically stable patients with STEMI and low-complex anatomy. However, in these trials, planned staged revascularization in the staged group was performed after hospital discharge rather than during the index admission. In those previous trials, the timing of staged revascularization was median 15 days (IQR 4-28) in the BIOVASC trial and median 37 days (IQR 30-43) in the MULTISTARS AMI trial, and most clinical events in the staged group (mainly due to unplanned revascularization and myocardial infarction) had occurred during the early phase after the index procedure with the possibility of progression of a non-infarct related artery (non-IRA) lesion before the staged procedure. Greater inflammatory status during the acute phase of myocardial infarction might be associated with these findings. The OPTION-STEMI trial, which compared immediate and staged complete revascularization during index hospitalization, failed to demonstrate non-inferiority for the primary endpoint at 1 year (13% in the immediate complete revascularization group and 11% in the staged complete revascularization group; hazard ratio 1.24; 95% confidence interval 0.86-1.79; P for non-inferiority = 0.024). Therefore, it remains unclear whether the treatment effect differs between in-hospital and out-of-hospital staged complete revascularization in patients with STEMI and multivessel disease. The investigators designed a prospective, open-label, multicenter, superiority trial to evaluate the efficacy and safety of in-hospital staged complete revascularization compared with out-of-hospital staged complete revascularization in patients with STEMI and multivessel disease. Non-IRA lesions with 50-69% stenosis will be assessed using FFR, whereas those with ≥ 70% stenosis will undergo revascularization without FFR assessment. The investigators hypothesize that in-hospital staged complete revascularization may mitigate the risk of early progression of non-IRA lesions, compared with out-of-hospital staged complete revascularization, without increasing the procedural risk associated with immediate complete revascularization.
- Study Hypothesis: In-hospital staged complete revascularization would reduce the risk of the primary composite endpoint (a composite of all-cause death, non-fatal myocardial infarction, or all unplanned revascularization) at 12 months compared with out-of-hospital staged complete revascularization in patients with STEMI and multivessel disease.
Tipo de estudo
Intervencional
Inscrição (Estimado)
1252
Estágio
- Não aplicável
Contactos e Locais
Esta seção fornece os detalhes de contato para aqueles que conduzem o estudo e informações sobre onde este estudo está sendo realizado.
Contato de estudo
- Nome: Min Chul Kim, MD, PhD
- Número de telefone: 82-10-4606-2643
- E-mail: kmc3242@hanmail.net
Locais de estudo
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Bucheon-si, Coréia do Sul
- Bucheon Sejong Hospital
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Changwon, Coréia do Sul
- Gyeongsang National University Changwon Hospital
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Changwon, Coréia do Sul
- Samsung Changwon Medical Center
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Cheonan, Coréia do Sul
- Soon Chun Hyang University Hospital Cheonan
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Cheongju-si, Coréia do Sul
- Chungbuk National University Hospital
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Chuncheon, Coréia do Sul
- Kangwon National University Hospital
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Daegu, Coréia do Sul
- Keimyung University Dongsan Hospital
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Daegu, Coréia do Sul
- Kyungpook National University Hospital
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Daegu, Coréia do Sul
- Daegu Catholic University Medical Center
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Daegu, Coréia do Sul
- Yeongnam University Medical Center
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Daejeon, Coréia do Sul
- Chungnam National University Hospital
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Gwangju, Coréia do Sul
- Chonnam National University Hospital
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Gwangju, Coréia do Sul
- Chosun University Hospital
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Gwangju, Coréia do Sul
- Gwangju Veterans Hospital
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Gwangju, Coréia do Sul
- Kwangju Christian Hospital
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Gwangmyeong, Coréia do Sul
- Chung-Ang University Gwangmyeong Hospital
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Jeju City, Coréia do Sul
- Jeju National University Hospital
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Jeonju, Coréia do Sul
- Jeonbuk National University Hospital
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Jeonju, Coréia do Sul
- Presbyterian Medical Center
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Jinju, Coréia do Sul
- Gyeongsang National University Hospital
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Pusan, Coréia do Sul
- Pusan National University Hospital
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Pusan, Coréia do Sul
- Inje University Haeundae Paik Hospital
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Pusan, Coréia do Sul
- Inje University Busan Paik Hospital
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Pusan, Coréia do Sul
- Kosin University Gospel Hospital
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Seoul, Coréia do Sul
- Korea University Anam Hospital
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Seoul, Coréia do Sul
- Koera University Guro Hospital
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Seoul, Coréia do Sul
- Yonsei University Health System, Gangnam Severance Hospital
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Suncheon, Coréia do Sul
- St. Carollo General Hospital
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Suwon, Coréia do Sul
- Ajou University Hospital
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Yangsan, Coréia do Sul
- Pusan National University Yangsan Hospital
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Critérios de participação
Os pesquisadores procuram pessoas que se encaixem em uma determinada descrição, chamada de critérios de elegibilidade. Alguns exemplos desses critérios são a condição geral de saúde de uma pessoa ou tratamentos anteriores.
Critérios de elegibilidade
Idades elegíveis para estudo
- Adulto
- Adulto mais velho
Aceita Voluntários Saudáveis
Não
Descrição
Inclusion Criteria:
- Age ≥19 years
- ST-segment elevation myocardial infarction (STEMI): ST-segment elevation ≥ 0.1 mV in at least two contiguous leads, or New-onset left bundle branch block (LBBB)
- Primary PCI within 12 h after symptom development
- At least 1 non-infarct related artery (non-IRA) with diameter ≥ 2.5 mm and 50% stenosis by visual estimation
Exclusion Criteria:
- Cardiogenic shock at initial presentation or after infarct-related artery (IRA) treatment
- Thrombolysis in myocardial infarction flow at non-IRA ≤ 2
- Severe procedural complications during primary percutaneous coronary intervention that, in the judgement of the operator, preclude study enrollment
- Non-IRA lesion unsuitable for percutaneous coronary intervention (PCI) treatment that, in the judgement of the operator, preclude study enrollment
- Chronic total occlusion in a non-IRA
- History of anaphylaxis to contrast agent
- Pregnancy and lactation
- Life expectancy < 1 year
- Severe valvular heart disease
- History of coronary artery bypass grafting (CABG) or planned CABG
- Fibrinolysis therapy prior to admission
- Severe asthma
Plano de estudo
Esta seção fornece detalhes do plano de estudo, incluindo como o estudo é projetado e o que o estudo está medindo.
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
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Comparador Ativo: Out-of-hospital staged complete revascularization
In the out-of-hospital staged complete revascularization group, PCI of non-IRA lesions will be performed after discharge and between 15 and 45 days of randomization.
Non-IRA lesion which have equal or more than 70% diameter stenosis by visual estimation will be revascularized without FFR evaluation.
Non-IRA lesion with diameter stenosis 50-69% by visual estimation will be evaluated using FFR device.
In case of FFR value more than 0.8, non-IRA lesion will be deferred without PCI.
If FFR value was equal or less than 0.8, non-IRA lesion will be revascularized.
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PCI of non-IRA lesions will be performed after discharge and between 15 and 45 days of randomization.
Non-IRA lesion which have equal or more than 70% diameter stenosis by visual estimation will be revascularized without FFR evaluation.
Non-IRA lesion with diameter stenosis 50-69% by visual estimation will be evaluated using FFR device.
In case of FFR value more than 0.8, non-IRA lesion will be deferred without PCI.
If FFR value was equal or less than 0.8, non-IRA lesion will be revascularized.
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Experimental: In-hospital staged complete revascularization
In the in-hospital staged complete revascularization group, PCI of non-IRA lesions will be performed on a separate day during the index hospitalization, at least 48 hours after PCI of the IRA.
Non-IRA lesion which have equal or more than 70% diameter stenosis by visual estimation will be revascularized without FFR evaluation.
Non-IRA lesion with diameter stenosis 50-69% by visual estimation will be evaluated using FFR device.
In case of FFR value more than 0.8, non-IRA lesion will be deferred without PCI.
If FFR value was equal or less than 0.8, non-IRA lesion will be revascularized.
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PCI of non-IRA lesions will be performed on a separate day during the index hospitalization, at least 48 hours after PCI of the IRA.
Non-IRA lesion which have equal or more than 70% diameter stenosis by visual estimation will be revascularized without FFR evaluation.
Non-IRA lesion with diameter stenosis 50-69% by visual estimation will be evaluated using FFR device.
In case of FFR value more than 0.8, non-IRA lesion will be deferred without PCI.
If FFR value was equal or less than 0.8, non-IRA lesion will be revascularized.
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Prazo |
|---|---|
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Composite of all-cause death, nonfatal myocardial infarction, or all unplanned revascularization
Prazo: At 12 months after randomization
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At 12 months after randomization
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Medidas de resultados secundários
Medida de resultado |
Prazo |
|---|---|
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Composite of all-cause death, nonfatal myocardial infarction, or all unplanned revascularization
Prazo: At 1, 6, 24, 36, 48, and 60 months after randomization
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At 1, 6, 24, 36, 48, and 60 months after randomization
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All-cause death
Prazo: At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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Nonfatal myocardial infarction
Prazo: At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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All unplanned revascularization
Prazo: At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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Cardiac death
Prazo: At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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Non-cardiac death
Prazo: At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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Nonfatal spontaneous myocardial infarction
Prazo: At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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Nonfatal procedure-related myocardial infarction
Prazo: At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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Target-lesion revascularization
Prazo: At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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Target-vessel revascularization
Prazo: At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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Non-target vessel revascularization
Prazo: At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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Hospitalization for unstable angina
Prazo: At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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Hospitalization for heart failure
Prazo: At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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Stent thrombosis
Prazo: At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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Stroke
Prazo: At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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Major bleeding
Prazo: At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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At 1, 6, 12, 24, 36, 48, and 60 months after randomization
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Contrast-induced nephropathy
Prazo: At hospital discharge (up to 30 days)
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At hospital discharge (up to 30 days)
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Colaboradores e Investigadores
É aqui que você encontrará pessoas e organizações envolvidas com este estudo.
Patrocinador
Investigadores
- Investigador principal: Youngkeun Ahn, MD, PhD, Chonnam National University Hospital
Datas de registro do estudo
Essas datas acompanham o progresso do registro do estudo e os envios de resumo dos resultados para ClinicalTrials.gov. Os registros do estudo e os resultados relatados são revisados pela National Library of Medicine (NLM) para garantir que atendam aos padrões específicos de controle de qualidade antes de serem publicados no site público.
Datas Principais do Estudo
Início do estudo (Estimado)
1 de setembro de 2026
Conclusão Primária (Estimado)
31 de julho de 2031
Conclusão do estudo (Estimado)
31 de julho de 2035
Datas de inscrição no estudo
Enviado pela primeira vez
26 de julho de 2026
Enviado pela primeira vez que atendeu aos critérios de CQ
30 de julho de 2026
Primeira postagem (Real)
3 de agosto de 2026
Atualizações de registro de estudo
Última Atualização Postada (Real)
17 de agosto de 2026
Última atualização enviada que atendeu aos critérios de controle de qualidade
13 de agosto de 2026
Última verificação
1 de agosto de 2026
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
Outros números de identificação do estudo
- CNUH-2026-258
Plano para dados de participantes individuais (IPD)
Planeja compartilhar dados de participantes individuais (IPD)?
NÃO
Informações sobre medicamentos e dispositivos, documentos de estudo
Estuda um medicamento regulamentado pela FDA dos EUA
Não
Estuda um produto de dispositivo regulamentado pela FDA dos EUA
Não
Essas informações foram obtidas diretamente do site clinicaltrials.gov sem nenhuma alteração. Se você tiver alguma solicitação para alterar, remover ou atualizar os detalhes do seu estudo, entre em contato com register@clinicaltrials.gov. Assim que uma alteração for implementada em clinicaltrials.gov, ela também será atualizada automaticamente em nosso site .