Unstable Angina Pectoris, Coronary Stent Implantation
Conditions
Keywords
Unstable Angina, Stent, Ticagrelor, Platelet aggregation, Percutaneous Coronary Intervention, Coronary Artery Disease, Major Adverse Cardiovascular and Cerebrovascular Events, Bleeding Events
Brief summary
The study is to evaluate efficacy and safety of low dose of ticagrelor therapy for Chinese unstable angina patients treated with non-urgent coronary stent implantation, to examine whether lower dose ticagrelor (45 mg twice-daily) is not inferior to standard dose (90 mg twice-daily) for the prevention of major adverse cardiovascular and cerebrovascular events, as well as will reduce the incidence of bleeding during long-term treatment.
Detailed description
This is a prospective, single center, randomized, parallel-group trial designed to evaluate the efficacy and safety of low dose ticagrelor on a background of aspirin for patients treated with non-urgent coronary stent implantation. 2036 subjects will be enrolled. All patients will receive treatment with aspirin and a P2Y12 inhibitor for 3 months after the index procedure. At 3 months, eligible patients were then randomly assigned in a 1:1 ratio to receive a standard dose ticagrelor 90 mg bid or a lower dose ticagrelor 45 mg bid in addition to aspirin 100mg. The primary efficacy end points are the event rate of the composite of cardiovascular death, non-fatal myocardial infarction, stent thrombosis, coronary revascularization and stroke at 24 months. The primary safety end point is the incidence of PLATO major bleeding at 24 months.
Interventions
DRUGTicagrelor 90 mg
Ticagrelor (AZD6140) 90 mg twice daily dose
DRUGTicagrelor 45 mg
Ticagrelor (AZD6140) 45 mg twice daily dose
DRUGAspirin
Aspirin 100 mg once daily dose
Sponsors
Xiaofan Wu
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Eligible patients were randomly assigned in a 1:1 ratio to receive ticagrelor 90 mg twice daily plus aspirin 100mg once daily or ticagrelor 45 mg twice daily plus aspirin 100mg once daily.
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Patients admission for coronary artery disease treatment with non-emergency percutaneous intervention with stent deployment * 18 years≤age≤80 years * Patients understands the study requirements and the treatment procedures and provided informed consent before the procedure
Exclusion criteria
* Allergy or intolerance to ticagrelor or aspirin * Need for oral anticoagulation therapy * Concomitant oral or intravenous therapy with strong inhibitors of Cytochrome P450, family 3, subfamily A (CYP3A), Substrates of CYP3A with narrow therapeutic indices or strong inducers of CYP3A * Active bleeding, previous history of intracranial hemorrhage, gastrointestinal hemorrhage in the past 6 months and major operation within 30 days * High risk of bradyarrhythmias * Severe liver dysfunction and abnormal renal function * Patient is a woman who is pregnant or nursing * Unable or unwilling to give written informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) and major bleeding event | Randomization up to 24 months | Participants with death from vascular causes, non-fatal myocardial infarction, stent thrombosis, coronary revascularization and stroke. Intention to treat (ITT) analysis of whole population. Events were adjudicated by an endpoint committee. Participants with PLATO major bleeding event including fatal bleeding, intracranial bleeding, intrapericardial bleeding with cardiac tamponade, hypovolemic shock or severe hypotension due to bleeding and requiring pressures or surgery, a decline in the hemoglobin level of 5.0 g per deciliter or more, or the need for transfusion of at least. Events were adjudicated by an endpoint committee. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Any event from the composite of cardiovascular death, non-fatal myocardial infarction, stent thrombosis, coronary revascularization and stroke | Randomization up to 24 months | Participants with any event from the composite of cardiovascular death, non-fatal MI, stent thrombosis, coronary revascularization and stroke. ITT analysis of intent for invasive management population. Events were adjudicated by an endpoint committee. |
| All cause death | Randomization up to 24 months | Participants with all cause death. ITT analysis of whole population. Events were adjudicated by an endpoint committee. |
| PLATO-defined any bleeding event | Randomization up to 24 months | Participants with any other bleeding events (minor bleeding or minimal bleeding) as defined by the PLATO. Events were adjudicated by an endpoint committee. |
Other
| Measure | Time frame | Description |
|---|---|---|
| PLATO-defined any minor bleeding event | Randomization up to 24 months | To compare two intensities of ticagrelor therapy on minor bleeding event as any bleeding requiring medical intervention but not meeting the criteria for major bleeding. Events were adjudicated by an endpoint committee. |
| PLATO-defined any minimal bleeding event | Randomization up to 24 months | To compare two intensities of ticagrelor therapy on minimal bleeding event as all other bleeding (eg, bruising, bleeding gums, oozing from injection site) not requiring intervention or treatment. Events were adjudicated by an endpoint committee. |
| Other adverse events | Randomization up to 24 months | To compare two intensities of ticagrelor therapy on other adverse events including dyspnea or bradyarrhythmia. Events were adjudicated by an endpoint committee. |
| Experiment examination | Randomization up to 24 months | To compare two intensities of ticagrelor therapy on increase of serum uric acid or creatinine. Events were adjudicated by an endpoint committee. |
Countries
China
Contacts
Primary ContactXiaofan Wu, MD
Outcome results
None listed