Coronary Artery Disease
Conditions
Keywords
DAPT, Dual antiplatelet therapy, high bleeding risk, HBR, Coronary artery disease, Percutaneous coronary intervention, PCI
Brief summary
BIOFLOW-DAPT is a prospective, multi-center, international, two-arm randomized controlled clinical study. A total of 1'948 subjects will be randomized 1:1 to receive either Orsiro Mission or Resolute Onyx. After index procedure, all patients will receive DAPT (ASA + P2Y12 inhibitor) for 30 days, followed by monotherapy with either P2Y12 inhibitor or ASA only until the end of the study. Clinical follow-up visits will be scheduled at 1, 6 and 12 months post-procedure.
Interventions
DEVICEPercutaneous coronary intervention
It's a non-surgical procedure that uses a catheter to place a stent into a coronary blood vessel in order to open up the vessel.
Sponsors
Biotronik AG
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Prospective, multi-center, international, two-arm randomized controlled clinical study.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Subject is acceptable candidate for treatment with a DES 2. Subject is considered at high bleeding risk (HBR), defined as meeting one or more of the following criteria at the time of enrollment: 1. ≥ 75 years of age 2. Moderate (estimated GFR 30-59 ml/min) or severe (estimated GFR \< 30 ml/min) chronic kidney disease or failure (dialysis dependent) 3. Advanced liver disease, defined as having cirrhosis with or without portal hypertension and with or without gastroesophageal varices. 4. Cancer (excluding non-melanoma skin cancer) diagnosed or treated within the previous 12 months or actively treated 5. Anemia with hemoglobin \< 11.0 g/dL or requiring transfusion within 4 weeks prior to randomization 6. Baseline thrombocytopenia defined as a platelet count \<100,000/mm3 7. History of stroke (ischemic or hemorrhagic), previous intracerebral hemorrhage (ICH) (spontaneous at any time or traumatic within the past 12 months) or presence of a brain arteriovenous malformation 8. History of hospitalization for bleeding within the previous 12 months 9. Chronic clinically significant bleeding diathesis 10. Clinical indication for chronic or lifelong oral anticoagulation (OAC) (with a vitamin K antagonist or non-vitamin K OAC) 11. Clinical indication for chronic or lifelong steroid or oral nonsteroidal anti-inflammatory drug(s) (NSAIDs), other than aspirin 12. Nondeferrable major surgery on DAPT 13. Recent major surgery or major trauma within 30 days before PCI 14. Precise DAPT score ≥ 25 3. Subject is ≥ 18 years or the minimum age required for legal adult consent in the country of enrollment 4. Subject is capable (no legally authorized representative allowed) to provide written informed consent as approved by the Institutional Review Board (IRB)/Ethics Committee (EC) of the respective clinical site prior to any study related procedure 5. Subject is willing to comply with all protocol and follow-up requirements, including agreement to discontinue DAPT at 1 month 6. Subject is eligible for dual antiplatelet therapy treatment with aspirin plus a P2Y12 inhibitor agent for 1-month post index procedure
Exclusion criteria
1. Subject who previously experienced a stent or scaffold thrombosis in any coronary vessel 2. Subject has a known allergy to all types of P2Y12 inhibitor (Clopidogrel, Ticagrelor, Prasugrel, Ticlopidine and Cangrelor; thus preventing the use of the appropriate P2Y12 inhibitor), aspirin, both heparin and bivalirudin, L-605 cobalt-chromium (Co-Cr) alloy or one of its major elements (cobalt, chromium, tungsten, nickel), molybdenum, platinum and irridium, silicon carbide, PLLA,polymers, mTOR inhibiting drugs such as zotarolimus or sirolimus, or contrast media 3. Revascularization of any target vessel within 9 months prior to the index procedure or previous PCI of any non-target vessel within 72 hours prior to or during the index procedure 4. 4\. Subject with documented left ventricular ejection fraction (LVEF) \<30% as evaluated by the most recent imaging exam (i.e. echocardiogram, ventriculogram, MUGA, etc.), but within 90 days pre/procedure or during the index procedure 5. Subject judged by physician as inappropriate for discontinuation from DAPT at 1 month following index procedure, due to another condition requiring chronic DAPT 6. Subject with planned surgery or procedure necessitating discontinuation of P2Y12 inhibitor and/or aspirin within the first month post-index procedure Note - planned staged procedure at the time of index procedure is not allowed 7. Active bleeding at the time of inclusion 8. Subject with a current medical condition with a life expectancy of less than 12 months 9. Subject is currently participating or intends to participate in another investigational drug or device trial within 12 months following the index procedure or any other clinical trial that may interfere with the treatment or protocol of this study 10. Subject is pregnant and/or breastfeeding or intends to become pregnant during the duration of the study 11. In the investigator's opinion, subject will not be able to comply with the follow-up requirements 12. Subjects who need an impartial witness to give an informed consent
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Composite of cardiac death, myocardial infarction (MI) and definite or probable stent thrombosis at 12 months | 12 months post-procedure |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of bleeding according to TIMI definition | until 12 months post-procedure | — |
| Rate of Device success | until 12 months post-procedure | Attainment of less than 30% residual stenosis of the target lesion using assigned stent only |
| Rate of definite/probable stent thrombosis according to the ARC definition | until 12 months post-procedure | — |
| Rate of MACCE | until 12 months post-procedure | composite of all-cause death, MI, and stroke |
| Rate of MACE | until 12 months post-procedure | composite of cardiac death, MI, and Target Vessel Revascularization (TVR) |
| Rate of cardiac death or MI | until 12 months post-procedure | all, target vessel related MI, Q-wave and non Q-wave, ST-related and non ST-related |
| Rate of all-cause death, cardiac, non-cardiac | until 12 months post-procedure | — |
| Rate of bleeding according to GUSTO definition | until 12 months post-procedure | — |
| Rate of clinically-indicated TVR | until 12 months post-procedure | — |
| Rate of clinically-indicated Target Lesion Revascularization (TLR) | until 12 months post-procedure | — |
| Rate of Target Vessel Failure (TVF) | until 12 months post-procedure | Composite of clinically-driven TVR, cardiac death or target-vessel related MI |
| Rate of target lesion failure (TLF) | until 12 months post-procedure | Composite of clinically driven TLR, cardiac death or target vessel related MI |
| Rate of bleeding according to BARC definition | until 12 months post-procedure | — |
| Rate of Procedure success | until 12 months post-procedure | Attainment of less than 30% residual stenosis of the target lesion using assigned stent only without occurrence of in-hospital major adverse cardiac events |
| Rate of stroke, ischemic and hemorrhagic | until 12 months post-procedure | — |
Countries
Australia, Austria, Belgium, Denmark, France, Germany, Hong Kong, Hungary, Italy, Latvia, Malaysia, Netherlands, New Zealand, Poland, Singapore, Spain, Switzerland, Thailand
Outcome results
None listed