Treatment of Functionally Non-significant Vulnerable Plaques in Patients With Multivessel ST-elevation Myocardial Infarction The VULNERABLE Trial

NCT ID: NCT05599061

Last Updated: 2026-01-29

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

600 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-01-30

Study Completion Date

2028-12-01

Brief Summary

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The study aims to compare a preventive percutaneous coronary intervention (PCI) plus optimal medical treatment (OMT) strategy vs. OMT for treatment of non-functionally significant non-culprit lesions presenting with optical coherence tomography (OCT) findings indicative of vulnerable plaque, in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease.

Detailed Description

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STEMI patients with multivessel disease planned for invasive evaluation of intermediate lesions (40-69% stenosis) are initially investigated with fractional flow reserve (FFR). Patients with FFR ≤ 0.80 are considered as screening failure and treated with PCI. Patients with FFR \> 0.80 are then investigated with optical coherence tomography (OCT). Patients without OCT findings of vulnerable plaque are treated with OMT and included in the OMT registry arm. Patients presenting with OCT characteristics of vulnerable plaque are included in the randomized trial comparing PCI with stent implantation plus OMT versus OMT.

Conditions

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Coronary Artery Disease Coronary Disease Ischemic Heart Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Optimal Medical Treatment (OMT) + PCI

Group Type EXPERIMENTAL

FFR>0.80+ OCT with findings indicative of vulnerable plaque

Intervention Type OTHER

Patients received OPTIMAL MEDICAL TREATMENT (OMT)+PCI

Optimal Medical Treatment (OMT)

Group Type ACTIVE_COMPARATOR

FFR>0.80+ OCT with findings indicative of vulnerable plaque

Intervention Type OTHER

OPTIMAL MEDICAL TREATMENT (OMT)

Interventions

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FFR>0.80+ OCT with findings indicative of vulnerable plaque

Patients received OPTIMAL MEDICAL TREATMENT (OMT)+PCI

Intervention Type OTHER

FFR>0.80+ OCT with findings indicative of vulnerable plaque

OPTIMAL MEDICAL TREATMENT (OMT)

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patients \> 18 years.
* Successful revascularization of the culprit lesion in patients undergoing coronary angiography due to ST-segment elevation (\> 1mm in \> 2 contiguous leads, new left bundle branch block, or true posterior MI with ST depression of \>1mm in \>2 contiguous anterior leads) in the first 72 hours of the symptom's onset.
* Multivessel coronary disease with non-culprit lesions located in different vessels than the culprit lesion and ranging from 40 to 69% of DS (visual estimated diameter stenosis ) by visual estimate planned for FFR-guided revascularization in staged procedure (\>24 hours and \<60 days after PCI of the culprit lesion).
* Non-culprit lesions should be suitable for functional assessment with pressure wire and OCT catheter and should be suitable to be treated with a single 2.0 to 4.5 mm EES (everolimus-eluting stent ).
* Subject agrees to not participate in any other clinical trial study for a period of 4 years following the inclusion in the study.
* Informed consent signed.

Exclusion Criteria

* Inability to provide informed consent.
* Female of childbearing potential (age \<50 years and last menstruation within the last 12 months), who did not undergo tubal ligation, ovariectomy or hysterectomy.
* Known intolerance to aspirin, heparin, everolimus, contrast material.
* Unresolved mechanical complication or cardiogenic shock at the staged procedure.
* Non-culprit study lesions located in the left main coronary artery or in coronary vessels with prior coronary revascularization (PCI or by-pass) or with distal vessel occlusion.
* Patients with long, bifurcated, severely angulated or severely calcified non-culprit study lesions non suitable to be treated with a single EES implantation.
* Asthma or known history of bronchial hyper-reactivity.
* Chronic renal dysfunction with creatinine clearance \< 45 ml/min.
* Severe comorbidities that in the opinion of the local investigators determine the patient's life expectancy \< 4 years.
* Subject is currently participating in another clinical trial that has not yet completed its primary endpoint.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Abbott

INDUSTRY

Sponsor Role collaborator

Fundación EPIC

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Hospital Universitari de Bellvitge

L'Hospitalet de Llobregat, Barcelona, Spain

Site Status RECRUITING

Hospital Universitario A Coruña

A Coruña, , Spain

Site Status RECRUITING

Hospital General Universitario de Albacete

Albacete, , Spain

Site Status RECRUITING

Hospital General Universitario Dr.Balmis

Alicante, , Spain

Site Status RECRUITING

Hospital Universitari Sant Joan D'Alacant

Alicante, , Spain

Site Status RECRUITING

Hospital Universitari Germans Trias I Pujol

Badalona, , Spain

Site Status RECRUITING

Hospital Del Mar

Barcelona, , Spain

Site Status RECRUITING

Hospital de Santa Creu I Sant Pau

Barcelona, , Spain

Site Status RECRUITING

Hospital Universitari Vall Hebron

Barcelona, , Spain

Site Status RECRUITING

Hospital Clinic de Barcelona

Barcelona, , Spain

Site Status RECRUITING

Hospital Universitario Puerta Del Mar

Cadiz, , Spain

Site Status RECRUITING

Hospital General Universitario de Castellón

Castellon, , Spain

Site Status RECRUITING

Hospital General Universitario de Ciudad Real

Ciudad Real, , Spain

Site Status RECRUITING

Hospital Universitario Reina Sofia de Cordoba

Córdoba, , Spain

Site Status RECRUITING

Hospital General Universitario de Elche

Elche, , Spain

Site Status RECRUITING

Hospital Universitario de Cabueñes

Gijón, , Spain

Site Status RECRUITING

Hospital Universitario de Girona Dr Trueta

Girona, , Spain

Site Status RECRUITING

Hospital Universitario San Cecilio

Granada, , Spain

Site Status RECRUITING

Chu de Toledo

Guadalajara, , Spain

Site Status RECRUITING

Hospital Universitario Juan Ramon Jimenez

Huelva, , Spain

Site Status RECRUITING

H.U. de Gran Canaria-Dr. Negrin

Las Palmas de Gran Canaria, , Spain

Site Status RECRUITING

H.I.U. Materno Infantil de Las Palmas

Las Palmas de Gran Canaria, , Spain

Site Status RECRUITING

Hospital Universitario de Leon

León, , Spain

Site Status RECRUITING

Hospital La Princesa

Madrid, , Spain

Site Status RECRUITING

Hospital Universitario Gregorio Marañon

Madrid, , Spain

Site Status RECRUITING

Hospital Universitario La Paz

Madrid, , Spain

Site Status RECRUITING

Hospital Universitario Puerta de Hierro

Majadahonda, , Spain

Site Status RECRUITING

Hospital de Manises

Manises, , Spain

Site Status RECRUITING

Hospital de Merida

Mérida, , Spain

Site Status RECRUITING

Hospital Universitario Virgen Arrixaca

Murcia, , Spain

Site Status RECRUITING

Hospital Universitario Central de Asturias

Oviedo, , Spain

Site Status RECRUITING

Hospital Universitari Son Espases

Palma de Mallorca, , Spain

Site Status RECRUITING

Hospital Universitario de Navarra

Pamplona, , Spain

Site Status RECRUITING

Hospital Clinico Universitario de Salamanca

Salamanca, , Spain

Site Status RECRUITING

Hospital Universitario de Donostia

San Sebastián, , Spain

Site Status RECRUITING

Hospital Universitario Nuestra Señora de La Candelaria

Santa Cruz de Tenerife, , Spain

Site Status RECRUITING

Hospital Universitario Marqués de Valdecilla

Santander, , Spain

Site Status RECRUITING

Hospital Clinico Universitario de Santiago de Compostela

Santiago de Compostela, , Spain

Site Status RECRUITING

Hospital Universitario Virgen Del Rocio

Seville, , Spain

Site Status RECRUITING

Hospital Universitari Joan Xxiii

Tarragona, , Spain

Site Status RECRUITING

Hospital Universitari MútuaTerrassa

Terrassa, , Spain

Site Status RECRUITING

Hospital Universitario de Torrevieja

Torrevieja, , Spain

Site Status RECRUITING

Hospital Universitario 12 Octubre

Usera, , Spain

Site Status RECRUITING

Hospital Clinico Universitario de Valencia

Valencia, , Spain

Site Status RECRUITING

Hospital General Universitario de Valencia

Valencia, , Spain

Site Status RECRUITING

Hospital Universitari I Politecnic La Fe

Valencia, , Spain

Site Status RECRUITING

Hospital Clínico Universitario de Valladolid

Valladolid, , Spain

Site Status RECRUITING

Hospital Clinico Universitario Lozano Blesa

Zaragoza, , Spain

Site Status RECRUITING

Hospital Universitari Miquel Servet

Zaragoza, , Spain

Site Status RECRUITING

Countries

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Spain

Central Contacts

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Josep Gomez-Lara, MD, PhD

Role: CONTACT

0034677255399

FUNDACION EPIC

Role: CONTACT

0034987225638

References

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Puymirat E, Cayla G, Simon T, Steg PG, Montalescot G, Durand-Zaleski I, le Bras A, Gallet R, Khalife K, Morelle JF, Motreff P, Lemesle G, Dillinger JG, Lhermusier T, Silvain J, Roule V, Labeque JN, Range G, Ducrocq G, Cottin Y, Blanchard D, Charles Nelson A, De Bruyne B, Chatellier G, Danchin N; FLOWER-MI Study Investigators. Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction. N Engl J Med. 2021 Jul 22;385(4):297-308. doi: 10.1056/NEJMoa2104650. Epub 2021 May 16.

Reference Type BACKGROUND
PMID: 33999545 (View on PubMed)

Mehta SR, Wood DA, Storey RF, Mehran R, Bainey KR, Nguyen H, Meeks B, Di Pasquale G, Lopez-Sendon J, Faxon DP, Mauri L, Rao SV, Feldman L, Steg PG, Avezum A, Sheth T, Pinilla-Echeverri N, Moreno R, Campo G, Wrigley B, Kedev S, Sutton A, Oliver R, Rodes-Cabau J, Stankovic G, Welsh R, Lavi S, Cantor WJ, Wang J, Nakamya J, Bangdiwala SI, Cairns JA; COMPLETE Trial Steering Committee and Investigators. Complete Revascularization with Multivessel PCI for Myocardial Infarction. N Engl J Med. 2019 Oct 10;381(15):1411-1421. doi: 10.1056/NEJMoa1907775. Epub 2019 Sep 1.

Reference Type BACKGROUND
PMID: 31475795 (View on PubMed)

Erlinge D, Maehara A, Ben-Yehuda O, Botker HE, Maeng M, Kjoller-Hansen L, Engstrom T, Matsumura M, Crowley A, Dressler O, Mintz GS, Frobert O, Persson J, Wiseth R, Larsen AI, Okkels Jensen L, Nordrehaug JE, Bleie O, Omerovic E, Held C, James SK, Ali ZA, Muller JE, Stone GW; PROSPECT II Investigators. Identification of vulnerable plaques and patients by intracoronary near-infrared spectroscopy and ultrasound (PROSPECT II): a prospective natural history study. Lancet. 2021 Mar 13;397(10278):985-995. doi: 10.1016/S0140-6736(21)00249-X.

Reference Type BACKGROUND
PMID: 33714389 (View on PubMed)

Stone GW, Maehara A, Ali ZA, Held C, Matsumura M, Kjoller-Hansen L, Botker HE, Maeng M, Engstrom T, Wiseth R, Persson J, Trovik T, Jensen U, James SK, Mintz GS, Dressler O, Crowley A, Ben-Yehuda O, Erlinge D; PROSPECT ABSORB Investigators. Percutaneous Coronary Intervention for Vulnerable Coronary Atherosclerotic Plaque. J Am Coll Cardiol. 2020 Nov 17;76(20):2289-2301. doi: 10.1016/j.jacc.2020.09.547. Epub 2020 Oct 15.

Reference Type BACKGROUND
PMID: 33069847 (View on PubMed)

Denormandie P, Simon T, Cayla G, Steg PG, Montalescot G, Durand-Zaleski I, le Bras A, le Breton H, Valy Y, Schiele F, Cuisset T, Vanzetto G, Levesque S, Goube P, Nallet O, Angoulvant D, Roubille F, Charles Nelson A, Chatellier G, Danchin N, Puymirat E. Compared Outcomes of ST-Segment-Elevation Myocardial Infarction Patients With Multivessel Disease Treated With Primary Percutaneous Coronary Intervention and Preserved Fractional Flow Reserve of Nonculprit Lesions Treated Conservatively and of Those With Low Fractional Flow Reserve Managed Invasively: Insights From the FLOWER-MI Trial. Circ Cardiovasc Interv. 2021 Nov;14(11):e011314. doi: 10.1161/CIRCINTERVENTIONS.121.011314. Epub 2021 Aug 23.

Reference Type BACKGROUND
PMID: 34420366 (View on PubMed)

Gomez-Lara J, Lopez-Palop R, Rumiz E, Jurado-Roman A, Gomez-Menchero A, Valencia J, Fernandez E, Goncalves Ramirez LR, Brugaletta S, Millan R, Cortes C, Tejedor P, Gutierrez-Barrios A, Flores X, Cid-Alvarez AB, Garcia-Blas S, Garcia-Camarero T, Linares Vicente JA, Vaquerizo B, Cordoba Soriano JG, Caballero J, Cardenal Piris RM, Sanchez-Elvira G, Oyarzabal L, Pernigotti A, Tramullas A, Antuna P, Rodriguez-Leor O, Ojeda S, Rossello X, Gomez-Hospital JA, Bermejo J, Garcia-Garcia HM, Perez de Prado A, Gutierrez-Ibanes E. [Treatment of functionally nonsignificant vulnerable plaques in multivessel STEMI: design of the VULNERABLE trial]. REC Interv Cardiol. 2024 Jul 4;6(4):278-286. doi: 10.24875/RECIC.M24000468. eCollection 2024 Oct-Dec.

Reference Type DERIVED
PMID: 40444169 (View on PubMed)

Other Identifiers

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EPIC28-VULNERABLE

Identifier Type: -

Identifier Source: org_study_id

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