Modulation of Fibrosis-inducing Pathways in Acute Myocardial Infarction

NCT ID: NCT05122741

Last Updated: 2023-01-25

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

Total Enrollment

50 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-12-01

Study Completion Date

2023-12-31

Brief Summary

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This is a single-center, prospective, observational controlled cohort study designed to describe the role of WNT/B-catenin signaling and adenosine system after an acute myocardial infarction, correlating it with clinical markers of fibrosis/remodeling (primary objective). The modulation of the aforementioned molecular patterns will also be evaluated in light of the type of P2Y12 inhibitor implemented (ticagrelor or prasugrel) to identify variations in response (secondary objective).

Detailed Description

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A total of 50 patients will be enrolled in the study, 40 with clinical presentation of acute myocardial infarction and eligible for treatment with either prasugrel or ticagrelor, and a control cohort of 10 patients with stable coronary artery disease, matched for age, sex and major risk factors, and with no history of prior myocardial infarction.

The study has been approved by the local ethics committee on 22/09/2021. Pre-enrollment screening will start from 01/11/2021. Blood samples will be obtained at 5 time-points: before and immediately after coronary revascularization (PCI) through the arterial introducer, and in the ward / clinic at a distance of 3, 5 days and 45±15 days from the procedure during normal routine examinations.

These will be used to study the expression of messenger RNA encoding for beta-catenin and to dose concentrations of beta-catenin, adenosine and cyclic adenosine monophosphate (cAMP) on serum. The extraction of RNA from blood samples will be carried out with a Real-time PCR method and the determination of molecules using ELISA colorimetric method, using specific kits.

Clinical-laboratory markers of left ventricular remodeling such as NT-proBNP, hsTnT, C-reactive protein, CK-MB, 12-lead ECG, transthoracic echocardiogram and cardiac magnetic resonance imaging, will be evaluated during hospitalization (at 3 and 5 days) and at the control visit (at 45 ± 15 days) as per standard clinical practice.

Conditions

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Myocardial Infarction Myocardial Fibrosis Myocardial Remodeling, Ventricular

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Acute Myocardial Infarction

40 patients with clinical presentation of acute myocardial infarction undergoing primary percutaneous coronary intervention and eligible for dual antiplatelet therapy (DAPT) with either prasugrel or ticagrelor on top of aspirin.

P2Y12 Potent Inhibitor + Aspirin for STEMI patients

Intervention Type DRUG

Patients will undergo primary percutaneous coronary intervention and DAPT with potent P2Y12 inhibitor (ticagrelor or prasugrel + aspirin)

Chronic Coronary Syndrome

10 patients with stable coronary artery disease with an indication, according to current guidelines, to percutaneous coronary intervention and subsequent DAPT with aspirin and clopidogrel.

Clopidogrel + Aspirin for CCS patients

Intervention Type DRUG

Patients will undergo elective percutaneous coronary intervention and DAPT with non-potent P2Y12 inhibitor (clopidogrel + aspirin)

Interventions

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P2Y12 Potent Inhibitor + Aspirin for STEMI patients

Patients will undergo primary percutaneous coronary intervention and DAPT with potent P2Y12 inhibitor (ticagrelor or prasugrel + aspirin)

Intervention Type DRUG

Clopidogrel + Aspirin for CCS patients

Patients will undergo elective percutaneous coronary intervention and DAPT with non-potent P2Y12 inhibitor (clopidogrel + aspirin)

Intervention Type DRUG

Other Intervention Names

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DAPT with Potent P2Y12i DAPT with Clopidogrel

Eligibility Criteria

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Inclusion Criteria

* Patients with ST segment elevation acute myocardial infarction undergoing coronary angiography and interventional treatment.\*

\* Patients with chronic coronary syndrome matched by age, sex and risk factors will also be screened and included as per study design.
* Patients with an indication to potent P2Y12 inhibitor therapy (i.e. ticagrelor or prasugrel) for acute myocardial infarction.
* Population equally amenable to ticagrelor or prasugrel therapy according to the italian drug instruction of use (IFU)

Exclusion Criteria

* Patients with a poor prognosis (less than 12 months)
* Patients admitted with cardiogenic shock or advanced cardiac failure (NYHA 4)
* Patients pre-treated before coronary angiography or in chronic therapy with a P2Y12 inhibitor
* Patients undergoing a medical only approach without percutaneous myocardial revascularization
* Patients undergoing surgical coronary revascularization
* Patients with prior history of myocardial infarction or prior coronary revascularization.
* Patients with contraindications or intolerance to antiplatelet therapy (ticagrelor, prasugrel, clopidogrel or cardioaspirin)
* Patients scheduled for a treatment with with cangrelor or GPIIb/IIIa inhibitors
* Patients with active bleeding at the time of inclusion
* Hemorrhagic diathesis
* Confirmed history of renal failure with glomerular filtration rate of \<30ml/min
* Severe hepatopathy
* Patients treated or scheduled for treatment with oral anticoagulant therapy
* Active cancer or diagnosis any proliferative disease within 5 years.
* Prior TIA or stroke (ischemic or hemorrhagic)
* Age \>75 years
* Weight \<60kg
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Natasha Irrera

UNKNOWN

Sponsor Role collaborator

Gianluca Di Bella

UNKNOWN

Sponsor Role collaborator

Antonio Micari

UNKNOWN

Sponsor Role collaborator

Roberto Licordari

UNKNOWN

Sponsor Role collaborator

University of Messina

OTHER

Sponsor Role lead

Responsible Party

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Francesco Costa

Doctor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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AOU Policlinico G. Martino

Messina, , Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Francesco Costa

Role: CONTACT

+390902212341

Facility Contacts

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Francesco Costa, Medicine

Role: primary

Roberto Licordari, Medicine

Role: backup

Other Identifiers

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Cardio1

Identifier Type: -

Identifier Source: org_study_id

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