Ischemic Postconditioning in STEMI Patients Treated With Primary PCI

NCT ID: NCT03787745

Last Updated: 2023-11-28

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

RECRUITING

Clinical Phase

NA

Total Enrollment

1800 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-02-04

Study Completion Date

2033-01-31

Brief Summary

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In a prospective, randomized clinical trial the iPOST2 trial will determine whether ischemic postconditioning reduces reperfusion injury and this will translate into improved clinical outcome of heart failure and death for STEMI patients who present with TIMI0-1 undergoing primary PCI

Detailed Description

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Myocardial reperfusion with the use primary percutaneous coronary intervention (PCI) is effective, but restoration of blood flow may itself jeopardize the myocardium, a phenomenon known as reperfusion injury.

In ischemic postconditioning (iPOST), repetitive interruptions of blood flow to the injured region applied after initial reperfusion, has been shown favorable with different modalities such as biomarkers, echocardiography and cardiac magnetic resonance.

However, the largest trial to date (DANAMI3-iPOST) failed to show clinical favor of iPOST when compared to conventional PCI. Importantly, however, in DANAMI3-iPOST thrombectomy was allowed and this might have impaired postconditioning, since thrombectomy itself creates reperfusion and thus reperfusion damage. Analysis of the fraction of DANAMI3-iPOST patients not undergoing thrombectomy showed a remarkable 45% reduction in death and heart failure in favor of postconditioning.

iPOST2 will investigate in a randomized, prospective and adequately powered trial the effect of iPOST without thrombectomy compared to conventional PCI on the development of heart failure and death in STEMI patients.

Conditions

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ST Segment Elevation Myocardial Infarction

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Prospective, randomized, placebo controlled
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
All study personell involved in outcome assessment will be blinded to the treatment employed

Study Groups

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Ischemic postconditioning

In addition to state of the art primary PCI in patients with TIMI0-1 ischemic postconditioning with an adequately sized balloon (60 reperfusion/60 seconds re-occlusion, four cycles) will be performed, however thrombectomy will not be allowed

Group Type ACTIVE_COMPARATOR

Ischemic postconditioning

Intervention Type PROCEDURE

After 60 seconds of reperfusion, ischemic postconditioning with an adequately sized balloon (60 reperfusion/60 seconds re-occlusion, four cycles) will be performed

Conventional

State of the art primary PCI in patients with TIMI0-1 will be performed, however thrombectomy will not be allowed

Group Type PLACEBO_COMPARATOR

Conventional

Intervention Type PROCEDURE

State of the art primary PCI, however thrombectomy is not allowed

Interventions

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Ischemic postconditioning

After 60 seconds of reperfusion, ischemic postconditioning with an adequately sized balloon (60 reperfusion/60 seconds re-occlusion, four cycles) will be performed

Intervention Type PROCEDURE

Conventional

State of the art primary PCI, however thrombectomy is not allowed

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Age ≥18 years
* Acute onset of chest pain with \< 12 hours duration
* STEMI as characterized by 2 mm ST elevation in 2 or more V1 through V4 leads or presumed new left bundle branch block with minimum of 1 mm concordant ST elevation or 1 mV ST-segment elevation in the limb lead (II, III and aVF, I, aVL) and V4-V6 or ST depression in 2 or more V1 through V4 leads indicating posterior AMI.
* TIMI flow 0-1 in infarct related artery

Exclusion Criteria

* Potential pregnancy
* Refusal to participate
* OHCA without subsequent consciousness despite ROSC
* Thrombectomy considered unavoidable
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Rigshospitalet, Denmark

OTHER

Sponsor Role lead

Responsible Party

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Thomas Engstrom

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Thomas Engstrøm, DMSci

Role: STUDY_CHAIR

Rigshospitalet, Denmark

Locations

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The Heart Center, Rigshospitalet, University of Copenhagen

Copenhagen, , Denmark

Site Status RECRUITING

Countries

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Denmark

Central Contacts

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Thomas Engstrøm, DMSci

Role: CONTACT

+4535458444

Jacob Lønborg, DMSci

Role: CONTACT

+4535458176

Facility Contacts

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Thomas Engstrøm, DMSci

Role: primary

References

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Engstrom T, Kelbaek H, Helqvist S, Hofsten DE, Klovgaard L, Clemmensen P, Holmvang L, Jorgensen E, Pedersen F, Saunamaki K, Ravkilde J, Tilsted HH, Villadsen A, Aaroe J, Jensen SE, Raungaard B, Botker HE, Terkelsen CJ, Maeng M, Kaltoft A, Krusell LR, Jensen LO, Veien KT, Kofoed KF, Torp-Pedersen C, Kyhl K, Nepper-Christensen L, Treiman M, Vejlstrup N, Ahtarovski K, Lonborg J, Kober L; Third Danish Study of Optimal Acute Treatment of Patients With ST Elevation Myocardial Infarction-Ischemic Postconditioning (DANAMI-3-iPOST) Investigators. Effect of Ischemic Postconditioning During Primary Percutaneous Coronary Intervention for Patients With ST-Segment Elevation Myocardial Infarction: A Randomized Clinical Trial. JAMA Cardiol. 2017 May 1;2(5):490-497. doi: 10.1001/jamacardio.2017.0022.

Reference Type RESULT
PMID: 28249094 (View on PubMed)

Other Identifiers

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H-18051256

Identifier Type: -

Identifier Source: org_study_id