Cardiovascular Magnetic Resonance for the Occluded Infarct-Related Artery Treatment

NCT ID: NCT00968383

Last Updated: 2015-05-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

11 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-09-30

Study Completion Date

2012-12-31

Brief Summary

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The purpose of this study is to determine whether opening an occluded infarcted artery 3-28 days after an acute myocardial infarction in high-risk asymptomatic patients with preserved infarct zone viability improves left ventricular systolic function and volumes at 6 months follow-up. The secondary purpose is to assess the changes in myocardial tissue characteristics after late percutaneous coronary intervention (PCI).

Detailed Description

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Rapid restoration of blood flow in the infarct-related artery (IRA), one of the cornerstones of contemporary treatment of acute myocardial infarction (MI) prevents myocardial necrosis and its consequences. However, due to late presentation or failed fibrinolytic therapy up to one third of patients have persistently occluded IRA after MI.

Recently, the Occluded Artery Trial (OAT) has demonstrated that percutaneous coronary intervention (PCI) with optimal medical therapy does not reduce the frequency of major adverse events compared to optimal medical therapy alone when performed on days 3-28 post MI in stable patients. Assessment of infarct zone viability was not used as an inclusion/exclusion criterion in the main OAT trial.

Several studies confirm that patients with left ventricular systolic dysfunction and preserved myocardial viability (necrosis transmurality\<50% in most segments of the infarct zone) assessed with magnetic resonance imaging benefit from revascularization.

Late opening of the occluded infarct-related artery only in patients with preserved myocardial tissue viability may lead to improvement of left ventricular volumes and function.

Conditions

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Cardiovascular Diseases Heart Diseases Myocardial Infarction Heart Failure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Optimal medical therapy

Conventional medical management, including aspirin, clopidogrel, statins, beta blockers, angiotensin converting enzyme (ACE) inhibitors and/or angiotensin receptor blocker (ARB) and/or aldosterone antagonist and risk factor modification

Group Type ACTIVE_COMPARATOR

Beta adrenergic blockers

Intervention Type DRUG

Participants will receive beta adrenergic blockers.

Platelet inhibitors

Intervention Type DRUG

Participants will receive platelet inhibitors.

Statins

Intervention Type DRUG

Participants will receive statins.

ACE inhibitors and/or ARB and/or AA

Intervention Type DRUG

Participants will receive ACE inhibitors and/or ARB and/or AA

PCI with optimal medical therapy

Conventional medical management, including aspirin, clopidogrel, statins, beta blockers, angiotensin converting enzyme (ACE) inhibitors and/or angiotensin receptor blocker (ARB) and/or aldosterone antagonist and risk factor modification plus percutaneous coronary intervention and coronary stenting

Group Type EXPERIMENTAL

Beta adrenergic blockers

Intervention Type DRUG

Participants will receive beta adrenergic blockers.

Platelet inhibitors

Intervention Type DRUG

Participants will receive platelet inhibitors.

Statins

Intervention Type DRUG

Participants will receive statins.

ACE inhibitors and/or ARB and/or AA

Intervention Type DRUG

Participants will receive ACE inhibitors and/or ARB and/or AA

PCI with stenting

Intervention Type PROCEDURE

Participants will undergo percutaneous coronary intervention (PCI) and coronary stenting.

Interventions

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Beta adrenergic blockers

Participants will receive beta adrenergic blockers.

Intervention Type DRUG

Platelet inhibitors

Participants will receive platelet inhibitors.

Intervention Type DRUG

Statins

Participants will receive statins.

Intervention Type DRUG

ACE inhibitors and/or ARB and/or AA

Participants will receive ACE inhibitors and/or ARB and/or AA

Intervention Type DRUG

PCI with stenting

Participants will undergo percutaneous coronary intervention (PCI) and coronary stenting.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Enrollment 3-28 days after an acute myocardial infarction.
* Infarct related artery occlusion (TIMI 0 or 1).
* High risk: left ventricular ejection fraction (LVEF)\<50% or LVEF\>50% and proximal coronary occlusion.
* Preserved infarct zone viability (necrosis transmurality \<50% in at least 4 segments out of 17 according to AHA classification).

Exclusion Criteria

* Unstable clinical condition
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Cardiology, Warsaw, Poland

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Lukasz A Malek, M.D. PhD

Role: PRINCIPAL_INVESTIGATOR

National Institute of Cardiology, Warsaw, Poland

Mariusz Kruk, M.D. PhD

Role: STUDY_CHAIR

National Institute of Cardiology, Warsaw, Poland

Mariusz Klopotowski, M.D.

Role: STUDY_CHAIR

National Institute of Cardiology, Warsaw, Poland

Locations

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Institute of Cardiology

Warsaw, , Poland

Site Status

Countries

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Poland

References

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Hochman JS, Lamas GA, Knatterud GL, Buller CE, Dzavik V, Mark DB, Reynolds HR, White HD; Occluded Artery Trial Research Group. Design and methodology of the Occluded Artery Trial (OAT). Am Heart J. 2005 Oct;150(4):627-42. doi: 10.1016/j.ahj.2005.07.002.

Reference Type BACKGROUND
PMID: 16209957 (View on PubMed)

Hochman JS, Lamas GA, Buller CE, Dzavik V, Reynolds HR, Abramsky SJ, Forman S, Ruzyllo W, Maggioni AP, White H, Sadowski Z, Carvalho AC, Rankin JM, Renkin JP, Steg PG, Mascette AM, Sopko G, Pfisterer ME, Leor J, Fridrich V, Mark DB, Knatterud GL; Occluded Artery Trial Investigators. Coronary intervention for persistent occlusion after myocardial infarction. N Engl J Med. 2006 Dec 7;355(23):2395-407. doi: 10.1056/NEJMoa066139. Epub 2006 Nov 14.

Reference Type BACKGROUND
PMID: 17105759 (View on PubMed)

Malek LA, Reynolds HR, Forman SA, Vozzi C, Mancini GB, French JK, Dziarmaga M, Renkin JP, Kochman J, Lamas GA, Hochman JS. Late coronary intervention for totally occluded left anterior descending coronary arteries in stable patients after myocardial infarction: Results from the Occluded Artery Trial (OAT). Am Heart J. 2009 Apr;157(4):724-32. doi: 10.1016/j.ahj.2008.12.008.

Reference Type BACKGROUND
PMID: 19332202 (View on PubMed)

Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med. 2000 Nov 16;343(20):1445-53. doi: 10.1056/NEJM200011163432003.

Reference Type BACKGROUND
PMID: 11078769 (View on PubMed)

Malek LA, Silva JC, Bellenger NG, Nicolau JC, Klopotowski M, Spiewak M, Rassi CH, Lewandowski Z, Kruk M, Rochitte CE, Ruzyllo W, Witkowski A. Late percutaneous coronary intervention for an occluded infarct-related artery in patients with preserved infarct zone viability: a pooled analysis of cardiovascular magnetic resonance studies. Cardiol J. 2013;20(5):552-9. doi: 10.5603/CJ.2013.0141.

Reference Type DERIVED
PMID: 24297771 (View on PubMed)

Other Identifiers

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2.50/V/09

Identifier Type: -

Identifier Source: org_study_id

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