A Randomized Trial of Early Discharge After Trans-Radial Stenting of Coronary Arteries in Acute MI - Full Text View

Sponsors and Collaborators:	Laval University Eli Lilly and Company Cordis Corporation Quebec Heart Institute
Information provided by:	Laval University
ClinicalTrials.gov Identifier:	NCT00440778

Purpose

HYPOTHESES

Bolus administration of total abciximab dose provides superior maximal and mean platelet aggregation inhibition (PAI) compared with standard bolus (0.25 mg/kg) administration.
Total dose of abciximab can be given as a single bolus and is more effective than bolus (0.25 mg/kg) + 12 hrs infusion in terms of acute and mid-term angiographic and clinical results.
Intracoronary (ic) abciximab administration is more effective than intravenous (iv) route of administration in terms of acute and mid-term angiographic and clinical results.
There is a relationship between PAI and angiographic perfusion scores.
Routine use of sirolimus-eluting stents (Cypher, Cordis) in primary-PCI is associated with a low rate of target vessel revascularization and complications.
Cardiac MRI early and late after primary-PCI provides detailed information on myocardial injury and irreversible necrosis, which are correlated with angiographic perfusion scores.
After uncomplicated trans-radial PCI, patients can be retransferred early to their referring center.

Condition	Intervention	Phase
Myocardial Infarction Ischemia	Drug: Abciximab	Phase IV

MedlinePlus related topics: Heart Attack

Drug Information available for: Abciximab

U.S. FDA Resources

Study Type:	Interventional
Study Design:	Treatment, Randomized, Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Dose Comparison, Parallel Assignment, Safety/Efficacy Study
Official Title:	A Randomized Trial of Early Discharge After Trans-Radial Stenting of Coronary Arteries in Acute Myocardial Infarction: The EASY-MI Pilot Study.

Further study details as provided by Laval University:

Primary Outcome Measures:

Percentage of patients with at least 95% platelet aggregation inhibition, and mean platelet aggregation inhibition. [ Time Frame: 10 min after bolus of abciximab ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:

Composite of death, stroke, repeat MI, urgent target vessel revascularization and major bleedings at 30 days following primary PCI. [ Time Frame: 30 days ] [ Designated as safety issue: No ]
Composite of cardiovascular death, repeat MI and repeat target vessel revascularization at 6-month follow-up. [ Time Frame: 6 months ] [ Designated as safety issue: No ]
Proportion of patients having myocardial blush grade 2-3 and TIMI 3 score at the end of PCI in the culprit vessel. [ Time Frame: At end of PCI ] [ Designated as safety issue: No ]
Restenosis rate (diameter stenosis â‰¥ 50%) and late loss in the culprit vessel at 6-month follow-up. [ Time Frame: 6 months ] [ Designated as safety issue: No ]
Exploratory end-points: feasibility and safety of early transfer to the referring hospital after uncomplicated primary PCI, cardiac MRI measurements and platelet aggregation inhibition at 6hr post-PCI. [ Time Frame: At 6hr post-PCI ] [ Designated as safety issue: No ]

Enrollment:	105
Study Start Date:	February 2007
Study Completion Date:	October 2008
Primary Completion Date:	October 2008 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Gr 1 - intracoronary + infusion: Experimental abciximab bolus 0.25 mg/kg ic + 12 hrs iv infusion	Drug: Abciximab 100% abciximab bolus dose (0.3 mg/kg) ic or iv vs standard bolus (0.25 mg/kg) ic or iv plus 12-hr infusion
Gr 2 - intracoronary: Experimental 100% abciximab bolus dose 0.3 mg/kg ic	Drug: Abciximab 100% abciximab bolus dose (0.3 mg/kg) ic or iv vs standard bolus (0.25 mg/kg) ic or iv plus 12-hr infusion
Gr 3 - intravenous: Active Comparator abciximab bolus dose 0.25 mg/kg iv + 12 hrs iv infusion	Drug: Abciximab 100% abciximab bolus dose (0.3 mg/kg) ic or iv vs standard bolus (0.25 mg/kg) ic or iv plus 12-hr infusion
Gr 4 - intravenous: Experimental 100% abciximab bolus dose 0.3 mg/kg iv	Drug: Abciximab 100% abciximab bolus dose (0.3 mg/kg) ic or iv vs standard bolus (0.25 mg/kg) ic or iv plus 12-hr infusion

Detailed Description:

OBJECTIVES AND END-POINTS The objectives of the present study are to assess the benefits and safety of 1) a single bolus of abciximab (100% dose) compared with the standard bolus (ca 80% of the total dose) + 12h infusion (ca 20% of the total dose), and 2) intracoronary abciximab bolus administration compared with intravenous route of abciximab administration in primary PCI.

The primary PLATELETS end-points are the percentage of patients with ≥ 95% platelet aggregation inhibition 10 minutes after abciximab bolus (MAX) and the mean platelet aggregation inhibition 10 minutes after abciximab bolus (MEAN).

The secondary CLINICAL end-points of the study are:

The composite of death, stroke, repeat myocardial infarction, urgent target vessel revascularization and major bleedings at 30 days following primary PCI.
The composite of cardiovascular death, repeat myocardial infarction and repeat target vessel revascularization at 6-months follow-up.

The secondary ANGIOGRAPHIC end-points of the study are:

The proportion of patients having myocardial blush grade 2-3 and TIMI 3 score at the end of PCI in the culprit vessel.
The restenosis rate (diameter stenosis ≥ 50%) and late loss in the culprit vessel at 6-months follow-up.

Other exploratory end-points are the feasibility and safety of early transfer to the referring hospital after uncomplicated primary PCI, the cardiac MRI measurements and platelet aggregation inhibition at 6h post-PCI.

Eligibility

Ages Eligible for Study:	18 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Patient with acute myocardial infarction eligible for primary PCI within 6 h of symptoms: patient must have prolonged, continuous (lasting at least 20 minutes) signs and symptoms of ischemia not eliminated with nitrates and onset within 6 h of randomization, and one of the following:
- ST-segment elevation ≥ 2 mm in 2 or more contiguous precordial ECG leads (anterior infarction)
- ST-segment depression ≥ 2 mm in V1, V2 or V2, V3 with reciprocal 1 mm ST-elevation in II, augmented unipolar foot (left leg) lead (AVF), and V6 (true posterior infarction)
- ST-segment elevation ≥ 1 mm in 2 or more contiguous limb ECG leads (other infarction)
- New or presumably new left bundle branch block (LBBB)
Patient must be > 18 years of age.
Patient and treating interventional cardiologist agree for randomization.
Patient will be informed of the randomization process and will sign an informed consent.
Diagnostic and therapeutic intervention performed through trans-radial/ulnar artery approach.
The culprit lesion can be identified on a native coronary vessel, which is suitable for primary PCI with stent implantation.

Exclusion Criteria:

Patient has received thrombolytic therapy (within the last 4 weeks) and is referred for rescue PCI
Concurrent participation in other investigational study
Femoral sheath (artery)
Intolerance or allergy to ASA, clopidogrel or ticlopidine precluding treatment for at least 12 months
Any significant blood dyscrasia, diathesis or INR > 2.0
Any clinical contraindication to abciximab (ReoPro®) administration i.e. known structural intracranial lesion, thrombocytopenia < 100,000, active or recent bleeding or hemoglobin level known < 10 g/dl.
Any glycoprotein IIb-IIIa inhibitors use in the previous 30 days
Uncontrolled high blood pressure i.e. systolic blood pressure ≥ 180 mmHg and/or diastolic blood pressure ≥ 100 mmHg.
Life expectancy less than 6 months owing to non-cardiac cause
Infarction caused by in-stent thrombosis or restenosis
Cardiogenic shock evident before randomization

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00440778

Locations

Canada
Laval Hospital
Quebec, Canada, G1V 4G5

Sponsors and Collaborators

Laval University

Eli Lilly and Company

Cordis Corporation

Quebec Heart Institute

Investigators

Principal Investigator:

Olivier F Bertrand, MD, PhD

Laval Hospital Research Center

More Information

Responsible Party:	Hopital Laval ( Olivier F Bertrand, MD PhD )
Study ID Numbers:	EASY-MI
Study First Received:	February 23, 2007
Last Updated:	October 7, 2008
ClinicalTrials.gov Identifier:	NCT00440778
Health Authority:	Canada: Health Canada

Keywords provided by Laval University:

Coronary artery stenting
Trans-radial
Intracoronary

Study placed in the following topic categories:

Necrosis
Heart Diseases
Myocardial Ischemia
Vascular Diseases

Abciximab
Ischemia
Infarction
Myocardial Infarction

Additional relevant MeSH terms:

Anticoagulants
Pathologic Processes
Therapeutic Uses
Hematologic Agents

Platelet Aggregation Inhibitors
Cardiovascular Diseases
Pharmacologic Actions

ClinicalTrials.gov processed this record on January 14, 2009