Invasive vs Conservative Strategies in Non-ST-elevation Acute Coronary Syndrome and Comorbidities

NCT ID: NCT01645943

Last Updated: 2016-10-26

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

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

109 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-01-31

Study Completion Date

2015-03-31

Brief Summary

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The guidelines of clinical practice, based on the randomized studies, recommend an invasive strategy in non-ST elevation acute coronary syndrome (NSTEACS). However, patients with comorbidities are excluded from the randomized studies and the observational registries showthat patients with comoribidities undergo fewer cardiac catheterizations. The aim is to investigate the benefit of the invasive strategy in patients with NSTEACS and comorbidities.

Patients hospitalized with NSTEACS, older than 70 years and with significant comorbidities, will be included. The latter will be defined as at least 2 of the following: peripheral artery disease, cerebral vascular disease, dementia, chronic pulmonary disease, chronic renal failure and anemia. The included patients will be randomized to an invasive (routine coronary angiogram) or conservative (coronary angiogram only if recurrent or inducible ischemia) strategy. All patients will receive medical treatment according to current recommendations.

The main outcome will be death, reinfarction or readmissions by heart cause at one-year follow-up. The hypothesis is that an invasive strategy will improve prognosis in patients with NSTEACS and comorbidities.

Detailed Description

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Conditions

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Acute Coronary Syndrome

Keywords

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Non-ST-elevation acute myocardial infarction Comorbidities

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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Conservative

Coronary angiogram only if recurrent ischemia or peristent heart failure or inducible ischemia in predischarge stress test if perfomed

Group Type NO_INTERVENTION

No interventions assigned to this group

Invasive

Routine coronary angiogram

Group Type ACTIVE_COMPARATOR

Coronary angiogram

Intervention Type PROCEDURE

Routine coronary angiogram and revascularization if indicated

Interventions

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Coronary angiogram

Routine coronary angiogram and revascularization if indicated

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Age =\>70 years old
* Angina chest pain
* Troponin elevation
* At least 2 of the following comorbidities: A) Documented peripheral artery disease. B)Renal filaure (GFR \<45 ml/min/m2). C) Neurological disease with permanent deficit. D) Dementia (Pfeiffer test). E) Chronic pulmonary disease (Gold\>2 or ambulatory oxigen therapy). Anemia (Hb =\<11 g/dl)

Exclusion Criteria

* Dynamic ST changes (=\>1 mm) in the initial ECG
* Prior known non-revascularizable coronay disease
* Concomitant heart disease different to coronary disease
* Life expentancy \< 1 year
Minimum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Instituto de Salud Carlos III

OTHER_GOV

Sponsor Role collaborator

University of Valencia

OTHER

Sponsor Role lead

Responsible Party

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Juan Sanchis

Full Professor of Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Juan Sanchis, Full Prof

Role: PRINCIPAL_INVESTIGATOR

University of Valencia. University Clinic Hospital

Locations

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Hospital Pujol i Trias

Badalona, Barcelona, Spain

Site Status

Hopsital Clinic

Barcelona, Barcelona, Spain

Site Status

Hospital Virgen del Rosell

Cartagena, Murcia, Spain

Site Status

Hospital Clínico Universitario

Valencia, Valencia, Spain

Site Status

Hospital Valle Hebrón

Barcelona, , Spain

Site Status

Hospital Virgen Arrixaca

Murcia, , Spain

Site Status

Countries

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Spain

References

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Sanchis J, Nunez E, Barrabes JA, Marin F, Consuegra-Sanchez L, Ventura S, Valero E, Roque M, Bayes-Genis A, Del Blanco BG, Degano I, Nunez J. Randomized comparison between the invasive and conservative strategies in comorbid elderly patients with non-ST elevation myocardial infarction. Eur J Intern Med. 2016 Nov;35:89-94. doi: 10.1016/j.ejim.2016.07.003. Epub 2016 Aug 8.

Reference Type RESULT
PMID: 27423981 (View on PubMed)

Other Identifiers

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11/ 01595

Identifier Type: -

Identifier Source: org_study_id