Acute Myocardial Infarction
Conditions
Keywords
Patients with AMI
Brief summary
Background: Percutaneous coronary intervention (PCI) is a highly effective therapy for acute ST-elevation myocardial infarction (STEMI). Adjunctive therapy with glycoprotein (GP) IIb/IIIa inhibitor can result in increased patency and improved outcomes in STEMI patients, with thrombus, undergoing PCI. The investigation of novel dosing and delivery strategies of this therapy may help to further improve outcomes. Study design: Intracoronary Abciximab With Clearway Catheter trial is a randomized, open-label, multicenter, trial to evaluate the effect of an intracoronary (IC) bolus dose of abciximab delivered using the ClearWay™RX catheter versus an intravenous bolus (IV) of abciximab for STEMI with angiographically visible thrombus (Thrombus Grade \> 2). All patients in both arms will receive intravenous abciximab infusion following the PCI for 12 hours per standard practice. A total of 150 patients will be randomized 1:1 to treatment of the culprit artery with IC abciximab (75 subjects) or IV abciximab (75 subjects) in addition to an infusion regimen of abciximab administered intravenously and initiated following PCI. The primary endpoint chosen to evaluate this hypothesis is infarct size as assessed on Cardiac Magnetic Resonance (CMR). Clinical outcomes will be assessed for each subject through hospital discharge and at 30 day follow-up. Sample size: The number of patients included in this study was based on the estimation of the sample size needed to identify a statistically significant difference of the primary end-points between the two groups. The investigators estimated that 75 patients would be required in each study group to have a power of 80% to detect an absolute difference in the infarct size resolution of 15% with a two-sided alpha value of 0.05. Conclusion: The purpose of this study is to demonstrate that an IC bolus of abciximab delivered with the ClearWay™RX catheter added to a post-PCI intravenous infusion regimen of abciximab will result in significant additional clot resolution in vivo when compared with an IV bolus of abciximab when added to a post PCI intravenous infusion regimen of abciximab. The primary endpoint chosen to evaluate this hypothesis is infarct size as assessed on CMR.
Interventions
DRUGIntracoronary bolus wtih ClearWay™RX catheter
Intracoronary bolus with Clearway catheter
DRUGIV abciximab
IV abciximab + infusion
Sponsors
Gennaro Sardella
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. Patients (men or women) at least 18 years of age 2. STEMI: Presenting with ischemic chest discomfort \> 20 minutes and \<6 hours of duration suggestive of acute myocardial infarction AND ST elevation \> 1 mm (\> 0.1 mV) in two contiguous limb leads OR \> 2 mm (\> 0.2 mV) in two contiguous precordial leads 3. Must have signed the informed consent form prior to performance of study-related procedures 4. Native dominant and proximal culprit vessel 2.5 mm in diameter 5. Angiographically identifiable thrombus (presence of a filling defect within the coronary lumen surrounded by contrast medium observed in multiple projections, without calcium within the filling defect, or persistence of contrast medium within the coronary lumen) 6. Pre-PCI Thrombus score (TS) ≥ 2 (angiographically apparent thrombus that is \> ½ the vessel diameter) 7. Pre-PCI TIMI flow grade of 0-2
Exclusion criteria
1. Previous PCI of the IRA 2. Previous myocardial infarction or coronary artery bypass grafting 3. Cardiogenic shock 4. Three vessel disease 5. Left main disease 6. Severe valvular heart disease 7. Rescue PCI (PCI following fibrinolytic administration) 8. Facilitated PCI (PCI following fibrinolytic or GP IIb/IIIa inhibition) 9. Contraindication to GP IIb/IIIa inhibitors such as excess bleeding risk or thrombocytopenia 10. Current participation in another investigational trial 11.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Reduction in infarct size for the IC infusion group compared to the control as measured with cardiac MRI imaging | 24 months |
Secondary
| Measure | Time frame |
|---|---|
| Angiographic outcomes of lesion, flow, and myocardial perfusion using established and validated Quantitative Coronary Angiographic Methodology | 24 months |
Countries
Italy
Outcome results
None listed