STEMI Treatment Optimization by Ischemic Postconditioning and IVUS Guidance

NCT ID: NCT04775914

Last Updated: 2023-12-19

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

2500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-04-01

Study Completion Date

2031-02-01

Brief Summary

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The purpose of is study is to investigate whether ischemic postconditioning (iPOST) and intravascular ultrasound-guided (IVUS) percutaneous coronary intervention (PCI) improve the clinical outcome of patients with ST-segment elevation myocardial infarction treated with primary PCI.

Detailed Description

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Conditions

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ST Elevation Myocardial Infarction

Keywords

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Primary PCI Coronary angiography Intravascular ultra sound (IVUS)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

2x2 factorial

As a second randomization to the iPOST2 trial (ID: H-180512561,NCT03787745) patients are randomized 1:1 to either a) receiving ultrasound guidance before and after stent placement or b) no ultrasound, independently of randomization in the iPOST2 trial. The iPOST2 trial was initiated February 2019.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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PCI standard

Group Type ACTIVE_COMPARATOR

PCI + Ischemic conditioning

Intervention Type PROCEDURE

IPOST is repeated for 4 cycles (60 sec obstruction followed by 60 sec perfusion each) and followed by stent implantation with a 1.1/1.0 ratio of stent diameter/reference vessel diameter and a stent length sufficient to cover the entire lesion from healthy to healthy area of the vessel. During the first cycle of re-occlusion of full vessel occlusion is secured by a small injection of contrast.

PCI standard + ischemic conditioning

Group Type EXPERIMENTAL

PCI + Ischemic conditioning

Intervention Type PROCEDURE

IPOST is repeated for 4 cycles (60 sec obstruction followed by 60 sec perfusion each) and followed by stent implantation with a 1.1/1.0 ratio of stent diameter/reference vessel diameter and a stent length sufficient to cover the entire lesion from healthy to healthy area of the vessel. During the first cycle of re-occlusion of full vessel occlusion is secured by a small injection of contrast.

Stent with ultrasound

Group Type EXPERIMENTAL

Stent with ultrasound

Intervention Type PROCEDURE

IVUS catheters are to be advanced at least 20 mm distal to the culprit lesion. After administration of intracoronary nitroglycerine, an IVUS-pullback is to be performed at 0.5mm/second using a commercially available imaging system. Stent size and landing zones are decided based on the IVUS.

Stent without ultrasound

Group Type ACTIVE_COMPARATOR

Stent with ultrasound

Intervention Type PROCEDURE

IVUS catheters are to be advanced at least 20 mm distal to the culprit lesion. After administration of intracoronary nitroglycerine, an IVUS-pullback is to be performed at 0.5mm/second using a commercially available imaging system. Stent size and landing zones are decided based on the IVUS.

Interventions

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PCI + Ischemic conditioning

IPOST is repeated for 4 cycles (60 sec obstruction followed by 60 sec perfusion each) and followed by stent implantation with a 1.1/1.0 ratio of stent diameter/reference vessel diameter and a stent length sufficient to cover the entire lesion from healthy to healthy area of the vessel. During the first cycle of re-occlusion of full vessel occlusion is secured by a small injection of contrast.

Intervention Type PROCEDURE

Stent with ultrasound

IVUS catheters are to be advanced at least 20 mm distal to the culprit lesion. After administration of intracoronary nitroglycerine, an IVUS-pullback is to be performed at 0.5mm/second using a commercially available imaging system. Stent size and landing zones are decided based on the IVUS.

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.

Exclusion Criteria

Pre-PCI TIMI flow 0 or 1 Potential pregnancy Inability to provide informed consent Unwillingness to consent Unavoidable to use thrombectomy Spontaneous coronary artery dissection Time from symptoms onset to PPCI \> 12 hours Culprit in bypass graft Other reason for not including the patient


Potential pregnancy Inability to understand information in order to provide informed consent Unwillingness to consent Spontaneous coronary artery dissection Time from symptoms inset to PPCI \> 12 hours Culprit in bypass graft Other reason
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Thomas Engstrom

OTHER

Sponsor Role lead

Responsible Party

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Thomas Engstrom

Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Thomas Engstrøm, MD PhD DMSci

Role: STUDY_CHAIR

Rigshospitalet, Denmark

Jacob Lønborg, MD PhD DMSci

Role: STUDY_CHAIR

Rigshospitalet, Denmark

Francis Joshi, Md, PhD

Role: STUDY_CHAIR

Rigshospitalet, Denmark

Locations

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Heart Center, Rigshospitalet

Copenhagen, Capital Region, Denmark

Site Status RECRUITING

Countries

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Denmark

Central Contacts

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Thomas Engstrøm, MD PhD DSci

Role: CONTACT

Phone: +45 3545 8444

Email: [email protected]

Jacob Lønborg, MD PhD DMSci

Role: CONTACT

Phone: +45 3545 8176

Email: [email protected]

Facility Contacts

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Thomas Engstrom, MD PhD DSci

Role: primary

Jacob Lønborg

Role: backup

Other Identifiers

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H-18051256b

Identifier Type: -

Identifier Source: org_study_id