Death, Sudden, Cardiac, Myocardial Infarction
Conditions
Keywords
Heart Attack, Sudden Cardiac Death, Peri-infarct Zone, Omega-3 Fatty Acids, Biological Markers, Cytogenetic Analysis, Cardiac Arrest
Brief summary
Doctors use magnetic resonance imaging (MRI) to obtain detailed pictures of the inside of the body. This study will evaluate a new MRI technique in people who have recently had a heart attack. Researchers will also examine the effect of fish oil supplementation on heart health in study participants.
Detailed description
A new MRI technique to examine the heart was recently developed. In this study, researchers will use this new technique to evaluate the heart in people who have recently had a heart attack to determine whether a specific pattern of heart muscle damage is related to sudden cardiac death. This fatal condition, also known as cardiac arrest, occurs when the heart abruptly stops pumping blood to the body, resulting in loss of consciousness, absence of pulse, and a stop in breathing. The most common cause of sudden cardiac death is a heart attack. In addition to evaluating the new heart MRI technique, this study will also examine the effects of fish oil supplementation in people who have recently had a heart attack. Recent research has shown that omega-3 fatty acids, commonly found in fish oil, may be beneficial for people with heart conditions. Lastly, the study will determine whether specific biomarkers and genetic factors can help predict the likelihood of a person dying from sudden cardiac death after previously experiencing a heart attack. Apart from studying the likelihood of sudden cardiac death, This study will measure the change in structure and pumping function of the heart (known as ventricular remodeling) and this study will determine if the high dose of fish oil treatment will result in an improvement of the heart. This study will enroll people who have had a heart attack in the 2 to 4 weeks before study entry. At a baseline study visit, participants will undergo an MRI of their heart and complete an exercise stress test on a treadmill. A blood sample will be collected, and women will provide a urine sample for a pregnancy test. Questionnaires asking about diet, medical history, and emotions will also be completed. Participants will then be randomly assigned to receive either fish oil supplements or placebo on a daily basis for 6 months. Every 2 to 3 months, study researchers will call participants to check on their health and progress. At a study visit at Month 6, participants will undergo repeat baseline testing. After this visit, study researchers will call participants every 6 months for 3 years to follow up on participants' health status.
Interventions
4 grams of omega-3 fatty acids taken orally once per day for 6 months
Placebo tablets taken orally once per day for 6 months
Sponsors
Study design
Eligibility
Inclusion criteria
* Experienced a heart attack in the 2 to 4 weeks before study entry * Lives in the greater Boston area or adjacent regions (within a 50-mile radius of Boston)
Exclusion criteria
* Unable to undergo an MRI because of metallic implants (e.g., pacemakers, an implantable cardioverter defibrillator \[AICD\]) at time of study entry * Active cancer or any other terminal illness with an expected survival rate of less than 6 months after study entry * Significant kidney dysfunction with a glomerular filtration rate (GFR) of less than 60 mL/min in the 2 weeks before study entry * Inability to follow study procedures * Pregnant * Hemodynamic instability * Urgent clinical need for a pacemaker or AICD * Inaccessibility of medical records
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Effect of Omega-3 Fatty Acids on Adverse Left Ventricular Remodeling | Before and after study treatments | Measured as change in left ventricular end-systolic volume indexed to body surface area from baseline to post-treatment (6-months) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Effect of Omega-3 Fatty Acids on Non-Infarct Myocardial Fibrosis | Measured in the 3-year follow-up period after participant's last study visit | Measured as change in myocardial extracellular volume fraction of non-infarcted myocardium from baseline to post-treatment (6-months) |
| Effect of Omega-3 Fatty Acids on Left Ventricular Ejection Fraction | Measured in the 3-year follow-up period after participant's last study visit | Measured as change in left ventricular ejection fraction from baseline to post-treatment (6-months) |
| Effect of Omega-3 Fatty Acids on Infarct Size | Measured in the 3-year follow-up period after participant's last study visit | Measured as change in infarct size from baseline to post-treatment (6-months) |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| High Dose Omega-3 Fatty Acid Arm Participants will receive a highly purified form of omega-3 fatty acids for 6 months.
Omega-3 Fatty Acids (Fish Oil Supplements): 4 grams of omega-3 fatty acids taken orally once per day for 6 months | 180 |
| Placebo Arm Participants will receive placebo for 6 months.
Placebo: Placebo tablets taken orally once per day for 6 months | 178 |
| Total | 358 |
Baseline characteristics
| Characteristic | High Dose Omega-3 Fatty Acid Arm | Placebo Arm | Total |
|---|---|---|---|
| Age, Continuous | 60 years STANDARD_DEVIATION 10 | 58 years STANDARD_DEVIATION 10 | 59 years STANDARD_DEVIATION 10 |
| Region of Enrollment United States | 180 Participants | 178 Participants | 358 Participants |
| Sex: Female, Male Female | 32 Participants | 38 Participants | 70 Participants |
| Sex: Female, Male Male | 148 Participants | 140 Participants | 288 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 18 / 180 | 11 / 178 |
| serious Total, serious adverse events | 1 / 180 | 0 / 178 |
Outcome results
Effect of Omega-3 Fatty Acids on Adverse Left Ventricular Remodeling
Measured as change in left ventricular end-systolic volume indexed to body surface area from baseline to post-treatment (6-months)
Time frame: Before and after study treatments
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| High Dose Omega-3 Fatty Acid Arm | Effect of Omega-3 Fatty Acids on Adverse Left Ventricular Remodeling | -5.4 Percent Change | Standard Deviation 16.6 |
| Placebo Arm | Effect of Omega-3 Fatty Acids on Adverse Left Ventricular Remodeling | 1.2 Percent Change | Standard Deviation 20.9 |
Effect of Omega-3 Fatty Acids on Infarct Size
Measured as change in infarct size from baseline to post-treatment (6-months)
Time frame: Measured in the 3-year follow-up period after participant's last study visit
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| High Dose Omega-3 Fatty Acid Arm | Effect of Omega-3 Fatty Acids on Infarct Size | -8.8 Percent Change | Standard Deviation 39.9 |
| Placebo Arm | Effect of Omega-3 Fatty Acids on Infarct Size | -1.9 Percent Change | Standard Deviation 57.7 |
Effect of Omega-3 Fatty Acids on Left Ventricular Ejection Fraction
Measured as change in left ventricular ejection fraction from baseline to post-treatment (6-months)
Time frame: Measured in the 3-year follow-up period after participant's last study visit
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| High Dose Omega-3 Fatty Acid Arm | Effect of Omega-3 Fatty Acids on Left Ventricular Ejection Fraction | 4.8 Percent Change | Standard Deviation 11 |
| Placebo Arm | Effect of Omega-3 Fatty Acids on Left Ventricular Ejection Fraction | 2.1 Percent Change | Standard Deviation 12 |
Effect of Omega-3 Fatty Acids on Non-Infarct Myocardial Fibrosis
Measured as change in myocardial extracellular volume fraction of non-infarcted myocardium from baseline to post-treatment (6-months)
Time frame: Measured in the 3-year follow-up period after participant's last study visit
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| High Dose Omega-3 Fatty Acid Arm | Effect of Omega-3 Fatty Acids on Non-Infarct Myocardial Fibrosis | -2.1 Percent Change | Standard Deviation 14 |
| Placebo Arm | Effect of Omega-3 Fatty Acids on Non-Infarct Myocardial Fibrosis | 3.4 Percent Change | Standard Deviation 15 |