Efficacy Study of Nicorandil on Neointima

NCT ID: NCT02328521

Last Updated: 2015-01-21

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

48 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-12-31

Study Completion Date

2016-07-31

Brief Summary

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The investigators aim to investigate the effect of oral nicorandil on neointima after coronary drug-eluting stent implantation in patients with diabetic mellitus.

Detailed Description

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In the era of bare metal stent (BMS), the restenosis rate was about 25%. The introduction of drug-eluting stent (DES) reduces restenosis rate to 4%-10%. Neointimal hyperplasia and restenosis remain to be problems after DES implantation. Besides, DES causes an increase in uncovered struts, late stent thrombosis, neoatherosclerosis, and heterogeneous neointima. Diabetes mellitus (DM) results in increased risk for atherosclerosis, in-stent restenosis, neoatherosclerosis and late-stent thrombosis. Nicorandil, a hybrid of adenosine triphosphate-sensitive potassium (K-ATP) channel opener and nitrates, has been shown to reduce target vessel revascularization after stent implantation, target lesion revascularization after rotational atherectomy, and restenosis in patients undergoing percutaneous coronary intervention (PCI). Intracoronary optical coherence tomography(OCT) has emerged as a high-resolution imaging method for analysis of neointima that grows over the stent. We aim to examine the effect of nicorandil on the neointima after coronary DES implantation in patients with unstable angina and DM.

Conditions

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Angina, Unstable Diabetes Mellitus

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Nicorandil group

Drug: Nicorandil (Chugai Pharmaceutical Co, Japan). The first dose is given 8h before selective percutaneous coronary intervention, 10mg, oral. After the percutaneous coronary intervention, nicorandil is given for 30 days, 5mg each time, 3 times daily oral.

Group Type EXPERIMENTAL

Nicorandil

Intervention Type DRUG

Nicorandil is given once before PCI and given 3 times daily for 30 days after PCI.

Control group

Drug: Nicorandil placebo (Sihuan Pharmaceutical Co, China). The first dose is given 8h before selective percutaneous coronary intervention, 2 tablets, oral. After the percutaneous coronary intervention, placebo is given for 30 days, 1 tablet each time, 3 times daily oral.

Group Type PLACEBO_COMPARATOR

nicorandil placebo

Intervention Type DRUG

Nicorandil placebo is given once before PCI and given 3 times daily for 30 days after PCI.

Interventions

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Nicorandil

Nicorandil is given once before PCI and given 3 times daily for 30 days after PCI.

Intervention Type DRUG

nicorandil placebo

Nicorandil placebo is given once before PCI and given 3 times daily for 30 days after PCI.

Intervention Type DRUG

Other Intervention Names

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Sigmart no other names

Eligibility Criteria

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Inclusion Criteria

* unstable angina with diabetes mellitus and is not given glibenclamide
* have clinical indication of percutaneous coronary intervention
* de novo severe stenosis in a native coronary artery
* lesion suitable for stent and optical coherence tomography examination
* reference vessel size between 2.5 and 4.0mm
* drug-eluting stent implantation only

Exclusion Criteria

* acute myocardial infarction within 2 weeks before percutaneous coronary intervention
* contraindications to treatment with nicorandil (allergy, glaucoma, digestive ulcer, is currently taking phosphodiesterase-5 inhibitor)
* bypass restenosis
* PCI history
* hypotension
* intolerance of platelet inhibitors and statins
* impaired liver function
* renal insufficiency requiring hemodialysis
* pregnancy
* connective tissue disease
* life expectancy ≤ 12 months
* left main coronary artery disease
* bypass graft lesion and lesions unsuitable for OCT
* unwillingness or inability to provide informed consent
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Zhang Ying Qian

OTHER

Sponsor Role lead

Responsible Party

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Zhang Ying Qian

M.D.

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Yundai Chen, M.D.

Role: PRINCIPAL_INVESTIGATOR

Chinese PLA General Hospital

Locations

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Chinese PLA General Hospital

Beijing, Beijing Municipality, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Ying Qian Zhang, M.D.

Role: CONTACT

86-15652505966

Facility Contacts

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Yundai Chen, M.D.

Role: primary

86-010-55499309

References

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IONA Study Group. Effect of nicorandil on coronary events in patients with stable angina: the Impact Of Nicorandil in Angina (IONA) randomised trial. Lancet. 2002 Apr 13;359(9314):1269-75. doi: 10.1016/S0140-6736(02)08265-X.

Reference Type BACKGROUND
PMID: 11965271 (View on PubMed)

Horinaka S, Yabe A, Yagi H, Ishimitsu T, Yamazaki T, Suzuki S, Kohro T, Nagai R; JCAD Study Investigators. Effects of nicorandil on cardiovascular events in patients with coronary artery disease in the Japanese Coronary Artery Disease (JCAD) study. Circ J. 2010 Mar;74(3):503-9. doi: 10.1253/circj.cj-09-0649. Epub 2010 Jan 18.

Reference Type BACKGROUND
PMID: 20081320 (View on PubMed)

Machecourt J, Danchin N, Lablanche JM, Fauvel JM, Bonnet JL, Marliere S, Foote A, Quesada JL, Eltchaninoff H, Vanzetto G; EVASTENT Investigators. Risk factors for stent thrombosis after implantation of sirolimus-eluting stents in diabetic and nondiabetic patients: the EVASTENT Matched-Cohort Registry. J Am Coll Cardiol. 2007 Aug 7;50(6):501-8. doi: 10.1016/j.jacc.2007.04.051. Epub 2007 Jul 23.

Reference Type BACKGROUND
PMID: 17678732 (View on PubMed)

Kawai Y, Hisamatsu K, Matsubara H, Dan K, Akagi S, Miyaji K, Munemasa M, Fujimoto Y, Kusano KF, Ohe T. Intravenous administration of nicorandil immediately before percutaneous coronary intervention can prevent slow coronary flow phenomenon. Eur Heart J. 2009 Apr;30(7):765-72. doi: 10.1093/eurheartj/ehp077. Epub 2009 Mar 10.

Reference Type BACKGROUND
PMID: 19276198 (View on PubMed)

Shehata M. Cardioprotective effects of oral nicorandil use in diabetic patients undergoing elective percutaneous coronary intervention. J Interv Cardiol. 2014 Oct;27(5):472-81. doi: 10.1111/joic.12142. Epub 2014 Aug 30.

Reference Type BACKGROUND
PMID: 25174952 (View on PubMed)

Nagoshi R, Shinke T, Otake H, Shite J, Matsumoto D, Kawamori H, Nakagawa M, Kozuki A, Hariki H, Inoue T, Ohsue T, Taniguchi Y, Iwasaki M, Nishio R, Hiranuma N, Konishi A, Kinutani H, Miyoshi N, Takaya T, Yamada S, Yasaka Y, Hayashi T, Yokoyama M, Kato H, Kadotani M, Ohnishi Y, Hirata K. Qualitative and quantitative assessment of stent restenosis by optical coherence tomography: comparison between drug-eluting and bare-metal stents. Circ J. 2013;77(3):652-60. doi: 10.1253/circj.cj-12-0610. Epub 2012 Dec 21.

Reference Type BACKGROUND
PMID: 23257388 (View on PubMed)

Tian F, Chen Y, Liu H, Zhang T, Guo J, Jin Q. Assessment of characteristics of neointimal hyperplasia after drug-eluting stent implantation in patients with diabetes mellitus: an optical coherence tomography analysis. Cardiology. 2014;128(1):34-40. doi: 10.1159/000357612. Epub 2014 Feb 7.

Reference Type BACKGROUND
PMID: 24514877 (View on PubMed)

Chen J, Zhou S, Jin J, Tian F, Han Y, Wang J, Liu J, Chen Y. Chronic treatment with trimetazidine after discharge reduces the incidence of restenosis in patients who received coronary stent implantation: a 1-year prospective follow-up study. Int J Cardiol. 2014 Jul 1;174(3):634-9. doi: 10.1016/j.ijcard.2014.04.168. Epub 2014 Apr 21.

Reference Type BACKGROUND
PMID: 24809921 (View on PubMed)

Other Identifiers

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S2014-120-01

Identifier Type: OTHER

Identifier Source: secondary_id

S2014-099-03

Identifier Type: -

Identifier Source: org_study_id

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