Non ST-segment Elevation Myocardial Infarction, ST-segment Elevation Myocardial Infarction
Conditions
Brief summary
In this trial we test the hypothesis that PCI and bivalirudin is superior to heparin alone (according to local protocol) in reducing death, MI, and major bleeding in patients with NSTEMI or STEMI at 180 days (primary end point), treated with ticagrelor or prasugrel.
Detailed description
The follow up of endpoints will be performed using SWEDEHEART and national registries. Follow up of primary endpoints and stroke will also be performed by telephone contacts with the patients or first degree relatives by a nurse phone call after 7 days and 180 days. The nurses will also accumulate hospital record information on these endpoints. A central adjudication will be performed for all reported primary endpoints for the first 180 days follow up. Every site will prepare source documents for the event and send it to UCR for central adjudication by an independent committee.
Interventions
DRUGbivalirudin
Will be administered as an intravenous bolus of 0.75 mg per kilogram, followed by an infusion of 1.75 mg per kilogram per hour). Bivalirudin will be administered alone or with a low dose of heparin up to 3000U heparin in lab or up to 5000 U given pre-hospital according to local practice.
DRUGHeparin
Treatment with unfractionated Heparin 5000 IU/ml i.v. ,Leo Pharma, Sweden, (the control group). Heparin in the control group is administered as an intravenous or intra-arterial bolus according to local practice. A dose of 70-100 U/kg is recommended
Sponsors
Lund University
Uppsala University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with a diagnosis of NSTEMI as judged by the physician in accordance with current guideline definitions (positive troponin) or, patients with a diagnosis of STEMI as defined by chest pain suggestive for myocardial ischemia for at least 30 minutes before hospital admission, time from onset of symptoms of less than 24 hours, and an ECG with new ST-segment elevation in two or more contiguous leads of ≥0.2 mV in leads V2-V3 and/or ≥0.1 mV in other leads or a probable new-onset left bundle branch block. * PCI of culprit lesion is intended (therapeutic PCI, not primarily diagnostic PCI). * Treated with bolus dose of ticagrelor or prasugrel before start of PCI. See 2.6 * Ability to provide informed consent * Age 18 years or older
Exclusion criteria
* Previous randomization in the VALIDATE-SWEDEHEART trial. * Known terminal disease with life expectancy less than one year. * Patients with known ongoing bleeding * Patients with uncontrolled hypertension in the opinion of the investigator * Patients with known subacute bacterial endocarditis * Patients with known severe renal (GFR \< 30 ml/min) and/or liver dysfunction * Patients with known thrombocytopenia or thrombocyte function defects * Any other contraindication for the study medications. * Heparin \> 5000U Before arriving to PCI lab or \> 3000 U given during angiography before randomization. * GpIIb/IIIa inhibitors have been given or are pre-planned to be given during the procedure.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Death, Myocardial infarction and major bleeding event | 180 days |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to primary endpoints (death, myocardial infarction and major bleeding event) | 180 days | Time to individual components of the primary end point (death, myocardial infarction and major bleeding). |
| Number of events where primary endpoints (death, myocardial infarction and major bleeding event) and stroke have been registered | 180 days | The primary end point combined with stroke as reported in the Swedish national patient registry. |
| Number of events where primary endpoints (death, myocardial infarction and major bleeding event) have been registered in heparin subgroups (U/kg, groups with certain max ACT values etc) | 180 days | — |
| TIMI flow grade after PCI | 180 days | — |
| Time to re-hospitalization with reinfarction | 180 days | Time to re-hospitalization with reinfarction as reported in Swedeheart |
| Time to all-cause death or re-hospitalization with myocardial infarction | 180 days | — |
| Time to target vessel revascularization | 180 days | Time to target vessel revascularization as reported in SWEDEHEART. |
| Death, Myocardial infarction and major bleeding events in the subgroups NSTEMI and STEMI | 180 days | — |
| Time to stent thrombosis | 180 days | Time to stent thrombosis as reported in SWEDEHEART. |
| Time to restenosis | 180 days | Time to restenosis as reported in SWEDEHEART. |
| Time to re-hospitalization with heart failure | 180 days | Time to re-hospitalization with heart failure as reported in SWEDEHEART. |
| Heart failure and complications of PCI during index hospitalization | 180 days | Heart failure and complications of PCI during index hospitalization as reported in SWEDEHEART |
| Minor bleeding during index hospitalization | 180 days | Minor bleeding during index hospitalization as reported in SWEDEHEART |
| Length of index hospital stay | 180 days | Length of index hospital stay as reported in SWEDEHEART |
| Bail-out use of GpIIb/IIIa | 180 days | Bail-out use of GpIIb/IIIa inhibitors during PCI |
| Time to target lesion revascularization | 180 days | Time to target lesion revascularization as reported in SWEDEHEART |
Countries
Sweden
Outcome results
None listed