Effect of Statin Preloading in STEMI in Improving PCI Outcomes

NCT ID: NCT04974814

Last Updated: 2022-07-21

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

NA

Total Enrollment

99 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-05-26

Study Completion Date

2023-04-30

Brief Summary

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To compare the effect of a single high dose of atorvastatin versus rosuvastatin preloading on microvascular coronary perfusion as determined by CTFC in patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI.

Detailed Description

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Acute myocardial infarction (MI) indicates irreversible myocardial injury resulting in necrosis of a significant portion of myocardium which is caused mostly by coronary plaque rupture or erosion. It could result in several clinical complications and impact cardiac prognosis .

Worldwide, ischemic heart disease is the single most common cause of death and its frequency is increasing, now Accounts for almost 1.8 million annual deaths.

Cholesterol reduction with HMG-CoA (3-hydroxy-3-methylglutaryl coenzyme A) reductase inhibitors or statins has been shown to improve mortality and cardiovascular morbidity in patients with established coronary artery disease (CAD).

Previous evidence suggests that statins have various favorable effects on vascular system that are not directly related to their impact on lipid metabolism. Beyond lowering lipids, statins have favorable effects on platelet adhesion, thrombosis, endothelial function, plaque stability, and inflammation. . As with ACS, the vascular injury from coronary angioplasty and stent placement induces platelet activation, thrombosis, and inflammation within the vessel wall and the distal microvasculature. Therefore, in addition to a long-term benefit associated with lipid lowering, statin therapy might play a beneficial role early after PCI.

Conventional TIMI flow grading (Thrombolysis In Myocardial Infarction) is a predictor of cardiac outcome after acute myocardial infarction and PCI, but it has several limitations.

The CTFC (corrected TIMI frame count) another approach to grade flow impairment, is an objective, quantitative, reproducible, and sensitive index for coronary blood flow\[9\].

TIMI flow may appear normal visually, but may correlate to abnormal CTFC. The CTFC has been proposed to have incremental prognostic accuracy in predicting survival outcome with reperfusion therapy . Higher CTFC values after PCI have also been found to be associated with poor clinical outcomes.

Conditions

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ST Elevation Myocardial Infarction

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The clinical study will be a prospective open label randomized controlled trial
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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control group

in this group patients will not receive statin before primary PCI

Group Type PLACEBO_COMPARATOR

Control Test

Intervention Type DRUG

patients in control arm will not preloaded with statin in ER before PCI

atorvastatin group

in this group patients will receive 80 mg atorvastatin single dose before primary PCI

Group Type ACTIVE_COMPARATOR

Atorvastatin 80mg

Intervention Type DRUG

patients in active arms will be preloaded with a single 80 mg atorvastatin in ER before PCI

rosuvastatin group

in this group patients will receive 40 mg rosuvastatin single dose before primary PCI

Group Type ACTIVE_COMPARATOR

Rosuvastatin 40mg

Intervention Type DRUG

patients in active arms will be preloaded with a single 40 mg rosuvastatin in ER before PCI

Interventions

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Rosuvastatin 40mg

patients in active arms will be preloaded with a single 40 mg rosuvastatin in ER before PCI

Intervention Type DRUG

Atorvastatin 80mg

patients in active arms will be preloaded with a single 80 mg atorvastatin in ER before PCI

Intervention Type DRUG

Control Test

patients in control arm will not preloaded with statin in ER before PCI

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* The Presence of symptoms (\<12h).
* ST-segment elevation of at least 0.1Mv in two contiguous leads of electrocardiogram or new onset left bundle branch block.
* Patients age 18 to 80 years.

Exclusion Criteria

* Previous (within 3 months) or current treatment with statins.
* Known allergy to heparin, aspirin, clopidogrel, or abciximab.
* Active severe bleeding.
* Pregnancy.
* History of major surgery or trauma.
* Significant gastrointestinal or genitourinary bleeding (\<6 weeks).
* History of cerebrovascular attack (within 2 years) or cerebrovascular attack with a significant residual neurological deficit.
* Cardiogenic shock with mechanical ventilation.
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Beni-Suef University

OTHER

Sponsor Role lead

Responsible Party

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Esraa M. Adel

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Esraa M Adel, bachelor

Role: PRINCIPAL_INVESTIGATOR

National Heart Institute

Ahmed A El berry, phd

Role: STUDY_DIRECTOR

Beni-Suef University

Raghda R Hussein, phd

Role: STUDY_DIRECTOR

Beni-Suef University

Ahmed A Abd el hamid

Role: STUDY_DIRECTOR

National Heart Institute

Locations

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National Heart Institute

Cairo, , Egypt

Site Status RECRUITING

Countries

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Egypt

Central Contacts

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Esraa M Adel, bachelor

Role: CONTACT

01026 028251

Raghda R Hussein, phd

Role: CONTACT

01010647666

References

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Elserafy AS, Farag NM, El Desoky AI, Eletriby KA. Effect of high-intensity statin preloading on TIMI flow in patients presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Egypt Heart J. 2020 Jul 10;72(1):40. doi: 10.1186/s43044-020-00074-0.

Reference Type RESULT
PMID: 32651772 (View on PubMed)

Jang Y, Zhu J, Ge J, Kim YJ, Ji C, Lam W. Preloading with atorvastatin before percutaneous coronary intervention in statin-naive Asian patients with non-ST elevation acute coronary syndromes: A randomized study. J Cardiol. 2014 May;63(5):335-43. doi: 10.1016/j.jjcc.2013.09.012. Epub 2013 Nov 9.

Reference Type RESULT
PMID: 24216317 (View on PubMed)

Ma M, Bu L, Shi L, Guo R, Yang B, Cao H, Luo L, Lu L. Effect of loading dose of atorvastatin therapy prior to percutaneous coronary intervention in patients with acute coronary syndrome: a meta-analysis of six randomized controlled trials. Drug Des Devel Ther. 2019 Apr 16;13:1233-1240. doi: 10.2147/DDDT.S196588. eCollection 2019.

Reference Type RESULT
PMID: 31354240 (View on PubMed)

Other Identifiers

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statin in STEMI

Identifier Type: -

Identifier Source: org_study_id

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