1-month DAPT Plus 5-month Ticagrelor Monotherapy Versus 12-month DAPT in Patients With Drug-coated Balloon

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

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

1948 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-11-01

Study Completion Date

2026-12-01

Brief Summary

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Drug-Coated Balloon (DCB) angioplasty is similar to plain old balloon angioplasty procedurally, but there is an anti-proliferative medication paclitaxel coated to the balloon. Treating ISR lesions with the DCB has the theoretical advantage of avoiding multiple stent layers and respecting the vessel anatomy. DCB has shown promising results for the treatment of ISR. Currently, DCB has a Class I indication to treat ISR recommended by European Society of Cardiology guidelines. In addition, some interventional cardiologist has also applied DCB in de novo lesions in their clinical practice.

Bleeding after PCI remains a substantial clinical problem. Bleeding post-PCI increases the risk of adverse outcomes such as death, non-fatal myocardial infarction, and prolongs hospital stay. Clinical data has suggested that major bleeding post-PCI would increase the risk of mortality 5.7-fold. The antiplatelet medications are the major cause of bleeding events post-PCI.

Current guidelines for stents recommended DAPT of aspirin plus a P2Y12 inhibitor for at least 12 months after stent implantation in patients with the acute coronary syndrome. Compared with the DES, because of the absence of metal inside the coronary artery, the use of DCB might theoretically allow shorter duration antiplatelet therapy. However, the optimal course of DAPT for the DCB treated patients remains controversial.

In 2013, the consensus from the German group suggested that for the acute coronary syndrome, DAPT should be used for 12 months. The consensus of DAPT developed by the European Society of Cardiology (ESC) in 2017 stated that "in patients treated with DCB, dedicated clinical trials investigating the optimal duration of DAPT are lacking." So far, there are no randomized data showing the optimal DAPT duration for the DCB treated patients.

In the current study, we use Aspirin + Ticagrelor for 1-month followed by Ticagrelor monotherapy for 5-month, afterward, Aspirin monotherapy for 6 months to be the antiplatelet regimen in the experimental arm, to compare with the Reference arm, which is Aspirin + Ticagrelor for 12-month in a non-inferiority statistical assumption, aiming to investigate the optimal duration of the DAPT in ACS patients after DCB treatment.

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Detailed Description

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Conditions

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Antiplatelet Drug Acute Coronary Syndrome Angioplasty, Balloon

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Experimental arm

1-month of Aspirin + Ticagrelor, followed by 5-month of Ticagrelor monotherapy; Afterward, Aspirin monotherapy for 6 months

Group Type EXPERIMENTAL

Aspirin 100mg for 1-month (immediately after PCI)

Intervention Type DRUG

Aspirin for 1-month immediately after PCI to be a part of medication treatment in the Experimental arm

Ticagrelor 90mg for 6-month (immediately after PCI)

Intervention Type DRUG

Ticagrelor for 6-month immediately after PCI to be a part of medication treatment in the Experimental arm

Aspirin 100mg for 6-month (6-month post PCI)

Intervention Type DRUG

Aspirin for 6-month at 6 months post-PCI (after the discontinuation of the 6-month Ticagrelor treatment) to be a part of medication treatment in the Experimental arm

Reference arm

12-month Aspirin plus Ticagrelor

Group Type ACTIVE_COMPARATOR

Aspirin 100mg for 12-month (immediately after PCI)

Intervention Type DRUG

Aspirin for 12-month immediately after PCI to be a part of medication treatment in the Reference arm

Ticagrelor 90mg for 12-month (immediately after PCI)

Intervention Type DRUG

Ticagrelor for 12-month immediately after PCI to be a part of medication treatment in the Reference arm

Interventions

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Aspirin 100mg for 1-month (immediately after PCI)

Aspirin for 1-month immediately after PCI to be a part of medication treatment in the Experimental arm

Intervention Type DRUG

Ticagrelor 90mg for 6-month (immediately after PCI)

Ticagrelor for 6-month immediately after PCI to be a part of medication treatment in the Experimental arm

Intervention Type DRUG

Aspirin 100mg for 6-month (6-month post PCI)

Aspirin for 6-month at 6 months post-PCI (after the discontinuation of the 6-month Ticagrelor treatment) to be a part of medication treatment in the Experimental arm

Intervention Type DRUG

Aspirin 100mg for 12-month (immediately after PCI)

Aspirin for 12-month immediately after PCI to be a part of medication treatment in the Reference arm

Intervention Type DRUG

Ticagrelor 90mg for 12-month (immediately after PCI)

Ticagrelor for 12-month immediately after PCI to be a part of medication treatment in the Reference arm

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Patients with an indication for PCI due to acute coronary syndrome
2. All target lesions can be successful treatment of PCI with drug-coated balloon (DCB)
3. Patients who are able to complete the follow-up and compliant to the prescribed medication

Exclusion Criteria

1. Under the age of 18 or Older than 80 years old
2. Unable to give informed consent
3. Patient is a woman who is pregnant or nursing (a pregnancy test must be performed within 7 days prior to the index procedure in women of child-bearing potential according to local practice)
4. Known contraindication to medications such as Heparin, antiplatelet drugs, or contrast.
5. Currently participating in another trial and not yet at its primary endpoint
6. Planned elective surgery
7. Concurrent medical condition with a life expectancy of less than 1 years
8. Previous intracranial haemorrhage
9. Need long-term oral anticoagulant therapy
10. Cardiogenic shock
11. Previous stent implantation 6 month
12. In-stent thrombosis
13. Target lesion located in surgical conduit

Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No