Nordic-Baltic Coronary Revascularization Study in Patients With Proximal Left Descending Coronary Artery (LAD) Lesion.

NCT ID: NCT03538886

Last Updated: 2021-04-06

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

4 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-06-01

Study Completion Date

2019-07-31

Brief Summary

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The Nordic-Baltic Heart Team Initiative for improved long-term coronary artery revascularization outcome compares quality of life and survival after coronary bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in patients with 1-vessel disease and proximal stenosis of the anterior descending artery (LAD/in patients with isolated proximal left descending coronary artery (LAD) lesion

Detailed Description

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It is not clear how operable 1-VD patients with stable or stabilized coronary artery disease involving a pLAD lesion should be treated to optimize long-term survival and quality of life.

According to recent European guidelines, significant pLAD disease may be treated by PCI or by CABG. This recommendation is based on two meta-analyses including 1.210 and 1.952 randomized and non-randomized patients. Generally, the patients were followed for 4-5 years. The analyses reported similar rates of mortality, MI and stroke, but more repeat revascularizations after PCI. Only one study including129 patients provided more than 5-year follow-up. Thus, the there is limited documentation for long-term effect of PCI vs. surgical re-vascularization in pLAD disease.

The American 2014 Guidelines on coronary revascularization recommends CABG for improved survival in patients with solitary proximal LAD stenosis. CABG

The angiographic 90% LIMA patency rate after 1, 2 and 3 decades is well described and suggestive of a survival benefit of surgical revascularization.

Therefore, there is scientific background for an CABG LIMA-to-LAD vs. PCI comparison in 1-VD patients with a pLAD lesion.

Substantiated expectations:

* PCI is superior to bypass operation concerning short-term quality of life.
* Off-pump LIMA-to-LAD is superior to PCI concerning long-term all-cause mortality.
* Long-term (≥10-year) follow-up is essential to evaluate coronary revascularization strategies.
* Outcome may be dependent on lesion complexity, diabetes and gender.

Conditions

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Coronary Artery Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

1:1 randomized clinical trial
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
The clinical outcomes will be assessed by an independent event committee with no knowledge of treatment allocation.

Study Groups

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Percutaneous coronary intervention (PCI)

Currently, percutaneous coronary intervention (PCI) using balloon and drug eluting stents is the treatment of choice for treatment of a proximal LAD lesion.

Group Type ACTIVE_COMPARATOR

Percutaneous coronary intervention (PCI)

Intervention Type PROCEDURE

Revascularization of LAD lesion by PCI

Coronary artery bypass grafting (CABG)

Coronary artery bypass grafting is a well established treatment with documented excellent long-term results for the treatment of proximal LAD lesion.

Group Type EXPERIMENTAL

Coronary artery bypass grafting (CABG)

Intervention Type PROCEDURE

Revascularization of LAD lesion by CABG

Interventions

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Coronary artery bypass grafting (CABG)

Revascularization of LAD lesion by CABG

Intervention Type PROCEDURE

Percutaneous coronary intervention (PCI)

Revascularization of LAD lesion by PCI

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

Heart Team decision on treatment

1-VD patients with stable coronary artery disease or stabilized unstable angina pectoris/NSTEMI or silent ischemia Proximal LAD (pLAD) stenosis (\>90% by visual assessment or FFR \<80% The lesion may be treated by both PCI and surgery

Exclusion Criteria

ST-elevation myocardial infarction within 24 hours. Expected survival \<1 year, because of high age or severe cardiac or non-cardiac disease.

Significant LM disease. Earlier CABG. PCI within 3 months. Significant valvular heart disease. Renal failure on dialysis Earlier disabling stroke Relative or absolute contraindication to dual antiplatelet therapy. Allergy relevant to the study treatments. Age \< 18 years. Study required information and consent suboptimal or impossible.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Oulu University Hospital

OTHER

Sponsor Role collaborator

Region Örebro County

OTHER

Sponsor Role collaborator

Pauls Stradins Clinical University Hospital

OTHER

Sponsor Role collaborator

Aalborg University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Leif Thuesen

Senior interventional cardiologist

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Leif Thuesen, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Cardiology, Aalborg University Hospital

Jan Jesper Andreasen, Prof

Role: PRINCIPAL_INVESTIGATOR

Department of Cardiothoracic Surgery, Aalborg University Hospital

Peter Sogaard, Prof

Role: STUDY_CHAIR

Department of Cardiology, aaalborg University Hospital

Locations

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Aalborg University Hospital

Aalborg, , Denmark

Site Status

Countries

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Denmark

Other Identifiers

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NOBLE-LAD_Protocol version 3

Identifier Type: -

Identifier Source: org_study_id

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