Optimizing Infarct Size by Transforming Emergent Stenting Into an Elective Procedure Study

NCT ID: NCT01462188

Last Updated: 2011-10-31

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

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-10-31

Study Completion Date

2015-10-31

Brief Summary

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The goal of primary PCI is to restore anterograde myocardial flow. Stenting a largely thrombotic lesion may determine distal embolisation of thrombotic material therefore deteriorating myocardial perfusion.

Detailed Description

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In the setting of largely thrombotic lesions such as those treated in the context of primary PCI, stenting often results in distal micro and macro-embolisation which hampers coronary flow and microvascular recovery. Interestingly in some of these studies comparing BMS versus balloon angioplasty an early hazard associated to the use of stent has been reported.

Thus, investigators hypothesize in this protocol that refraining from stenting during the acute phase of ST segment myocardial infarction is safe and associated to improved myocardial recovery as compared to acute stenting.

Conditions

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Myocardial Infarction

Keywords

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ST-segment elevation myocardial infarction Primary angioplasty stent

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Immediate stenting

Patients being randomized to the immediate stenting arm will be managed according to the guidelines. Irrespective of TIMI flow at presentation, investigators will be requested to thrombus aspirate immediately after successful wiring of the culprit vessel followed by direct stenting. In cases where insertion of thrombus removal catheter and/or direct stenting is not successful, balloon angioplasty will be allowed.

Group Type ACTIVE_COMPARATOR

Immediate stenting

Intervention Type PROCEDURE

Primary coronary stenting

Delayed stenting

Patients being randomized to the delayed/staged stenting arm will be managed with the aim to obtain stable TIMI 3 flow with no considerations given at the percentage of residual stenosis at the culprit lesion.

In patients presenting with TIMI 3 flow, investigators will be left free to wire the vessel and proceed to thrombus aspiration to decrease thrombus burden in the culprit lesion or to leave the vessel untreated at the time of index PCI. Patients presenting with suboptimal TIMI flow (i.e. less than 3), investigators are required to wire the vessel and thrombus aspirate. If stable (persisting for at least 5 minutes) TIMI 3 flow is obtained, investigators are requested to stop the procedure. The goal is to achieve s table TIMI 3 flow with no considerations given to the percentage of residual stenosis. Stenting in this arm will be allowed only on a bail-out strategy.

Group Type EXPERIMENTAL

Delayed stenting

Intervention Type PROCEDURE

Coronary stenting 3 to 7 days after having reopened the vessel in the acute phase

Interventions

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Immediate stenting

Primary coronary stenting

Intervention Type PROCEDURE

Delayed stenting

Coronary stenting 3 to 7 days after having reopened the vessel in the acute phase

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* chest pain for \>30 min with ST-segment elevation of one mm or more in 2 or more contiguous ECG leads or with presumably new left bundle-branch block
* admission either within 12 h of symptom onset or between 12 and 24 h with evidence of continuing ischaemia

Exclusion Criteria

* inability to assume an oral P2Y12 receptor blocker on a consecutive daily basis for a minimum of 6 months, or to heparin or aspirin
* uncontrolled hypertension (systolic or diastolic arterial pressure \>180 mmHg or 120, respectively, despite medical therapy)
* limited life expectancy, e.g. neoplasms, others
* inability to obtain informed consent
* pregnancy
* patients were not enrolled if they were clinically unstable, presented with severe arrhythmia, or had known contraindications to CMR (claustrophobia, pacemakers, or implantable defibrillator devices)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Marco Valgimigli

OTHER

Sponsor Role lead

Responsible Party

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Marco Valgimigli

Head of the Catheterization laboratory

Responsibility Role SPONSOR_INVESTIGATOR

Locations

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U.O. Cardiologia

Ferrara, Emilia-Romagna, Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Alessandro Dal Monte, MD

Role: CONTACT

Phone: 3487243479

Email: [email protected]

Marco Valgimigli, MD, PhD

Role: CONTACT

Phone: 3356478877

Email: [email protected]

Facility Contacts

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Alessandro Dal Monte, MD

Role: primary

Other Identifiers

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TRAPS-09-I

Identifier Type: -

Identifier Source: org_study_id