Coronary Artery Disease, Acute Coronary Syndrome
Conditions
Keywords
Percutaneous Coronary Intervention, Stents, Drug-Eluting Stents, Coronary Artery Disease, Acute Coronary Syndrome
Brief summary
PCI is considered as the reperfusion strategy of choice for patients with acute STEMI. Data from RCTs and meta-analyses demonstrate a consistent and strong signal towards a significant reduction in MACE among patients with STEMI undergoing primary PCI with newer generation stents with enhanced biocompatibility. The present trial aims at filling the current gap of evidence by providing randomized data to establish the superior clinical outcome with an ultrathin strut third-generation DES with biodegradable polymer designed to improve vascular healing in patients with STEMI undergoing primary PCI, compared to the current state-of-the art second-generation DES with permanent polymer.
Detailed description
Background Primary percutaneous coronary intervention (PCI) is considered nowadays as the reperfusion strategy of choice for patients with acute ST-segment elevation myocardial infarction (STEMI, owing to a lower risk of myocardial re-infarction and improved short- and long-term survival compared to fibrinolysis. However, STEMI is still associated with poorer clinical outcomes after PCI, compared to stable CAD, with higher rates of stent thrombosis and an increased risk of myocardial re-infarction persisting throughout long-term follow-up. recent data from randomized controlled trials and meta-analyses demonstrate a consistent and strong signal towards a significant reduction in major adverse cardiac events among patients with STEMI undergoing primary PCI with third-generation DESs, compared with both first-generation and second-generation DESs with durable polymer. Importantly, this signal suggesting superiority of third-generation DESs in patients with STEMI has never been demonstrated with second-generation DESs. Third-generation DESs with enhanced biocompatibility may therefore have a particular clinical benefit in high-risk subgroups of patients with delayed vascular healing but these data warrants confirmation in appropriately designed randomized controlled trials. Objective The purpose of the study is to compare the safety and efficacy of a novel biodegradable-polymer sirolimus-eluting stent (Orsiro®) with a durable-polymer everolimus-eluting stent (Xience Xpedition or Xience Alpine®) in a superiority trial among patients presenting with acute STEMI and undergoing primary PCI. Methods Eligible patients with acute STEMI presenting within 24 hours of symptom onset will undergo primary PCI. At PCI, the randomly allocated stent has to be implanted in the culprit lesion of the target vessel. Patients will be followed-up with a hospital visit at 12 months. Patients will be followed-up for clinical endpoints by telephone at 30 days and 2 years.
Interventions
Sponsors
University of Lausanne Hospitals
Insel Gruppe AG, University Hospital Bern
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
* Age ≥18 years * ST-segment elevation acute myocardial infarction * Primary PCI occurring within 24 hours of symptom onset * Presence of ≥1 acute infarct artery target vessel with one or more coronary artery stenoses in a native coronary artery from 2.25 to 4.0 mm in diameter that can be covered with one or multiple coronary stents
Exclusion criteria
* Known allergy to aspirin, Ticagrelor, Prasugrel, Clopidogrel, Sirolimus, Everolimus or contrast media * Planned surgery within 6 months of primary PCI, unless dual antiplatelet therapy could be maintained throughout the peri-surgical period * Currently participating in another trial before reaching the primary endpoint * Inability to provide informed consent * Non-cardiac comorbid conditions with life expectancy of less than 1 year * Mechanical complication of acute myocardial infarction * Acute myocardial infarction due to stent thrombosis
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Number of patients with target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction (Q-wave and non-Q-wave), or clinically driven target lesion revascularization | up to 12 months |
Secondary
| Measure | Time frame |
|---|---|
| Number of patients with clinically indicated and not clinically indicated target vessel revascularization (TVR) | up to 30 days, 1 and 2 years |
| Number of patients with target vessel failure (TVF) | up to 30 days, 1 and 2 years |
| Number of patients with cardiac death | up to 30 days, 1 and 2 years |
| Number of patients with clinically indicated and not clinically indicated target lesion revascularization (TLR) | up to 30 days, 1 and 2 years |
| Number of patients with myocardial infarction (Q-wave and non-Q-wave) | up to 30 days, 1 and 2 years |
| Number of patients with definite stent thrombosis | up to 30 days, 1 and 2 years |
| Number of patients with all-cause death (cardiac and non-cardiac) | up to 30 days, 1 and 2 years |
Countries
Switzerland
Outcome results
None listed