Atrial Fibrillation, Coronary Artery Disease
Conditions
Keywords
drug eluting stent, atrial appendage closure
Brief summary
Comparatively analyze the safety and validity of Amplazter Cardiac Plug (ACP) device-using percutaneous left atrial appendage closure, and the medical treatment with dabigatran plus aspirin or dabigatran plus clopidogrel after 3months triple therapy (Dabigatran plus DAPT (dual-antiplatelet therapy)) in patient with coronary artery disease treated with drug-eluting stent, accompanying atrial fibrillation. Total of 670 patients \[left atrial appendage occlusion registry with 100 ACP/ 570 anti-coagulation registry: (285 Dabigatran plus aspirin) and (285 Dabigatran plus clopidogrel) therapy)\] will be comparatively analyzed the safety and efficacy. Primary endpoints were a composite of death, non-fatal myocardial infarction, stroke, systemic embolism, and GUSTO bleeding (moderate to severe).
Interventions
DRUGDabigatrain plus aspirin
Dabigatran (Pradaxa®) is indicated for the prevention of thrombotic events (for example stroke or heart attack) in people with atrial fibrillation. Aspirin is indicated for the prevention of stent thrombosis and myocardial infarction in patients treated with drug-eluting stents. Patients will be randomized to stop clopidogrel (maintain dabigatran + aspirin) at 3 months after PCI.
DRUGDabigatrain plus clopidogrel
Clopidogrel is indicated for the prevention of stent thrombosis and myocardial infarction in patients treated with drug-eluting stents. Patients will be randomized to stop aspirin (maintain dabigatran + clopidogrel) at 3 months after PCI.
DEVICEAmplazter Cardiac Plug (ACP)
Patients allocated to the intervention group should be received percutaneous closure of the LAA by use of the ACP device (St. Jude Medical, St Paul, MN, USA).
Sponsors
Yonsei University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Patients older than 20 years accompanying chronic atrial fibrillation with CHADS2 score ≥2 2. Patients with coronary artery disease (which requires DES) should receive the 2nd generation drug-eluting stent insertion treatment 3. Subjects and their legal representatives must understand the main purpose of this study, agree with relevant provisions, and sign to consent forms approved by IRBs of each institution. 4. Subjects should agree with the follow-up studies as (coronary angiography) and transesophageal echocardiography, etc. 5. Subjects should agree to follow our requests for post-operative follow-up visits.
Exclusion criteria
1. Patients showing any hypersensitive reaction or reason for restriction to aspirin, heparin, clopidogrel, or warfarin, or otherwise, susceptible to contrast media, and therefore, who could not use those drugs and who were pregnant or breast feeding. 2. Comorbidities other than atrial fibrillation that required chronic warfarin use. 3. Patients diagnosed with progressive infection condition or endocarditis. 4. Patients who have been diagnosed with progressive gastric ulcer or upper gastrointestinal bleeding for last 3 months. 5. Hemodynamically unstable patients who needs inotropic supports. 6. Senile dementia patients who have experienced any cerebrovascular accident (CVA) for last 6 weeks. 7. Patients who have been diagnosed with intracardiac mass, thrombus, or vegetation as echocardiographic findings. 8. Patients diagnosed with severe left ventricular dysfunction (\<LVEF 30%). 9. Patients with blood disorder as followings: leucopenia (\<WBC 3,000mm3), acute anemia (\<Hg 9mg %), Thrombocytopenia (\<100,000 platelets/mm3), or any evidence of bleeding or clotting disorders. 10. Patients showing life expectancy less than 12 months because of noncardiac comorbidities. 11. Patients having severe vein occlusion at femoral vein, ceiling vein, or inferior vena cava. 12. A patent foramen ovale with atrial septal aneurysm and right-to-left shunt 13. Symptomatic carotid artery disease 14. Patients with severe valvular heart disease 15. Patients who are currently participating in other clinical trials for any drug or medical device.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| MACCE (Major adverse cardiac and cerebrovascular events) | 5 years |
| GUSTO bleeding | 5 years |
Secondary
| Measure | Time frame |
|---|---|
| Occurence of procedural related complications | 5 years |
Countries
South Korea
Outcome results
None listed