MEND-CABG (MC-1 to Eliminate Necrosis and Damage in Coronary Artery Bypass Graft Surgery) - Full Text View

Sponsored by:	Medicure
Information provided by:	Medicure
ClinicalTrials.gov Identifier:	NCT00157716

Purpose

The purpose of this study is to determine whether MC-1 is effective and safe in reducing cardiovascular and neurological events in patients undergoing high-risk coronary artery bypass surgery

Condition	Intervention	Phase
Coronary Artery Bypass Graft Surgery Myocardial Ischemia Reperfusion Injury Myocardial Revascularization	Drug: (MC-1) Pyridoxal-5’-phosphate	Phase II

MedlinePlus related topics: Coronary Artery Bypass Surgery Heart Attack Surgery

Drug Information available for: Pyridoxal phosphate Pyridoxine

U.S. FDA Resources

Study Type:	Interventional
Study Design:	Prevention, Randomized, Double-Blind, Placebo Control, Parallel Assignment, Safety/Efficacy Study
Official Title:	A Randomized, Double-Blind, Placebo-Controlled, Dose-Ranging, Multi-Center Study to Evaluate the Cardiovascular and Cerebrovascular Effects of MC-1 in Patients Undergoing High-Risk Coronary Artery Bypass Graft (CABG) Surgery

Further study details as provided by Medicure:

Primary Outcome Measures:

Combined incidence of cardiovascular death, nonfatal myocardial infarction and nonfatal cerebral infarction on days up to and including post-operative day 30.

Secondary Outcome Measures:

Combined incidence of cardiovascular death, nonfatal myocardial infarction and nonfatal cerebral infarction up to and including post-operative day (POD) 90
Incidence of cardiovascular death up to and including POD 4, POD 30, POD 90
Incidence of nonfatal myocardial infarction up to and including POD 4, POD 30, POD 90
Incidence of all cause morality up to and including POD 4, POD 30, POD 90
Global disability as measured by the Modified Rankin scale at POD 30 and POD 90
MMSE score at POD 30 and POD 90
Among patients with a confirmed cerebral infarction, severity of stroke as measured by the National Institutes of Health Stroke Scale (NIHSS) at the time of stroke diagnosis and at subsequent study visits up to and including POD 90
Psychometric testing results as measured by a short battery of tests at POD 4, POD 30 and POD 90 on a subset of approximately 150 volunteers per treatment arm
CK-MB AUC (0-24 hours)

Estimated Enrollment:	900
Study Start Date:	April 2004
Estimated Study Completion Date:	October 2005

Detailed Description:

Coronary artery bypass grafting (CABG) effectively relieves angina, results in longer survival, and a better quality of life in specific subgroups of patients with obstructive coronary artery disease. Due to the high incidence of coronary artery disease worldwide, as well as the effectiveness of the surgical procedure, CABG surgery makes up one of the top ten most frequently performed procedures in North America and Europe. In the United States it is estimated that over 700,000 CABG procedures are performed per year.

Despite the benefits of CABG surgery, patients undergoing these procedures may also suffer serious adverse outcomes including operative mortality, myocardial infarction, unstable angina, ventricular failure, life-threatening arrhythmia, renal insufficiency, and stroke.

Some of the proposed causes of cardiovascular morbidity and mortality after CABG include perioperative ischemia, inadequate myocardial protection and reperfusion injury. The impact of these serious complications is significant. Incidence rates of death and MI following CABG surgery range from 5% to 12% depending on risk status. Results from large clinical trials have recently demonstrated the importance of neurologic deficits as a problematic outcome of CABG. These deficits include memory impairment, psychomotor, visuospatial, attention and language abilities as measured by neuropsychological testing as well as sensori-motor abnormalities associated with stroke.

MC-1 is a naturally occurring small molecule. Evidence from pre-clinical and clinical studies suggests that MC-1 protects the heart from ischemic damage and ischemia-reperfusion injury. This trial will assess the effects of MC-1 compared to placebo on cardiovascular and neurological events following CABG surgery.

Eligibility

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

Criteria

Inclusion Criteria:

Patients must be scheduled to undergo CABG surgery (during routine scheduling times) planned to use cardiopulmonary bypass

Patients must be considered at high risk for subsequent neurological or myocardial complications defined as meeting 2 or more of the following:

Age >65
Current smoker
History of diabetes mellitus requiring treatment other than diet
Evidence of left ventricular dysfunction or congestive heart failure assessed by: ejection fraction (EF) <45%, left ventricular end diastolic pressure (LVEDP) or pulmonary wedge pressure greater than or equal to 20 mm Hg, pulmonary edema by chest X-ray, cardiothoracic ratio >50% on chest X-ray
History of a previous non-disabling stroke, transient ischemic attack, or carotid endarterectomy
Urgent CABG intervention defined as the need to stay in the hospital (although patient may be operated on within a normal scheduling routine
History of a myocardial infarction that occurred more than 48 hours but less than 6 weeks prior to CABG surgery
Prior peripheral artery surgery or angioplasty
Moderate renal dysfunction defined by creatinine ≥ 133 micromol/L (1.5 mg/dL), but < 250 micromol/L (2.8 mg/dL)
Presence of at least one asymptomatic carotid artery stenosis (≥50%) either in one or two carotid arteries

Exclusion Criteria:

Planned associated valve surgery or concurrent carotid endarterectomy
Planned aortic dissection repair or aortic root reconstruction
Screening visit occurring less than 4 hours before scheduled CABG surgery
MMSE score less than 24 at the screening visit
Current cardiogenic shock, acute left ventricular rupture, ventricular septal rupture, or papillary muscle rupture
Uncontrolled diabetes defined as fasting serum blood glucose value equal to or greater than 24 mmol/L (432 mg/dL) at the time of screening (if fasting serum blood glucose not obtained at screening, values obtained within 30 days prior to screening visit may be used)
Myocardial infarction occurring <48 hours prior to planned CABG surgery
Severe renal dysfunction defined as a serum creatinine value ≥ 250 micromol/L (2.8 mg/dL) or nephritic syndrome at screening (or obtained within 30 days prior to screening visit)
History of liver cirrhosis, chronic active hepatitis, or severe liver dysfunction , or liver transaminase ≥3 times ULN at screening (or obtained within 30 days prior to screening visit)
History of malignancy during last 5 years except for basal cell carcinoma
Planned surgery for atrial fibrillation
Pregnancy or potential for pregnancy
Any medical or psychiatric condition which in the opinion of the investigator makes the patient an unsuitable candidate for the study
History of alcohol or drug abuse within the past year
Participation in any other investigation drug or device study within 30 days of randomization

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00157716

Locations

United States, North Carolina
Duke University Medical Center
Durham, North Carolina, United States, 27710-7510
Canada, Quebec
Montreal Heart Institute
Montreal, Quebec, Canada, H1T 1C8

Sponsors and Collaborators

Medicure

Investigators

Principal Investigator:

Jean-Claude Tardif, MD, FRCPC, FACC

Montreal Heart Institute Research Centre

More Information

No publications provided

Study ID Numbers:	MC6021-CR-03-02
Study First Received:	September 8, 2005
Last Updated:	October 30, 2006
ClinicalTrials.gov Identifier:	NCT00157716 History of Changes
Health Authority:	United States: Food and Drug Administration; Canada: Health Canada

Keywords provided by Medicure:

Coronary
surgery
ischemia
reperfusion injury
cardiac

heart
neurological
cardiopulmonary bypass
cardioprotection

Study placed in the following topic categories:

Pyridoxal Phosphate
Heart Diseases
Vitamin B Complex
Myocardial Ischemia
Vascular Diseases
Trace Elements
Ischemia

Necrosis
Postoperative Complications
Pyridoxal
Vitamins
Pyridoxine
Micronutrients
Reperfusion Injury

Additional relevant MeSH terms:

Pyridoxal Phosphate
Heart Diseases
Vitamin B Complex
Myocardial Ischemia
Growth Substances
Physiological Effects of Drugs
Vascular Diseases
Ischemia

Pharmacologic Actions
Pathologic Processes
Postoperative Complications
Vitamins
Cardiovascular Diseases
Micronutrients
Reperfusion Injury

ClinicalTrials.gov processed this record on May 06, 2009