Acute Myocardial Infarction
Conditions
Brief summary
A pilot study planned to evaluate initial safety of ticagrelor monotherapy after coronary stenting due to acute myocardial infarction. The study is a single-centre, single-arm, prospective phase II study 200 patients who undergo coronary artery stenting due to NSTEMI or STEMI will be included. Primary endpoint (variable): The composite of cardiac death, spontaneous myocardial infarction or definite or probable stent thrombosis within 3 months.
Detailed description
A pilot study with 200 subjects undergoing coronary stenting due to NSTEMI or STEMI. All patients will undergo invasive coronary angiography and clinically indicated Percutaneous Coronary Intervention (PCI). PCI will be performed using EES and OCT guidance using the MLDMAX algorithm (Morphology, Length, Diameter, Medial dissection, Apposition, Xpansion). Eligibility criteria will be assessed after completion of PCI. Patients will be given a drug diary to document and as a reminder of the twice daily ticagrelor administration. The Data Safety Monitoring Board (DSMB) will continuously review the outcomes for these patients. After the first 50 patients have been recruited and at least 30 of these patients have reached 3-month follow-up or had the primary outcome, the DSMB will convene to decide whether it is safe to proceed with the study. However, the DSMB will strongly consider early termination of the trial if more than 10 primary endpoint events occur. Patients may be treated with aspirin prior to coronary angiography, as per local treatment guidelines. All patients will be followed for 1 year. After one year, all patients will be treated per the discretion of the treating physician.
Interventions
DRUGTicagrelor 90mg
All patients will be prescribed ticagrelor as monotherapy
Sponsors
Vastra Gotaland Region
Sahlgrenska University Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Single-centre, single-arm, prospective phase II study
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Men or women at least 18 years old. 2. Pre- or intra-procedure treatment with ticagrelor. 3. Coronary stenting with an everolimus-eluting stent (EES) due to NSTEMI or STEMI, with post-procedure diameter stenosis \<50% and post-procedure Thrombolysis In Myocardial Infarcton (TIMI) flow grade 3. 4. PCI guided by optical coherence tomography (OCT) with MLDMAX workflow 5. Subject has not yet received any post-procedure dose of aspirin or any post-procedure dose of a different P2Y12 inhibitor than ticagrelor (loading dose or pre-PCI maintenance dose of aspirin and/or a different P2Y12 inhibitor is allowed) 6. Subject has signed and dated the informed consent form.
Exclusion criteria
1. Planned PCI or any planned surgical intervention within the next 6 months. 2. Any indication for chronic anticoagulant therapy 3. Positive COVID-19 antigen or PCR test regardless of symptoms 4. History of definite stent thrombosis 5. Left main coronary artery stenting. 6. Stent thrombosis/restenosis as a culprit lesion. 7. Visible thrombus on angiography after PCI 8. Usage of glycoprotein IIb/IIIa inhibitors 9. Any bifurcation lesion with stenting of both branches. 10. Any treated lesion within an arterial or venous graft. 11. Any additional lesion(s) that need(s) a staged revascularization. 12. Known ejection fraction \<30%. 13. Known severe renal insufficiency (eGFR \<30 ml/min/1.72 m2). 14. Any life-threatening conditions or medical comorbidity resulting in life expectancy \< 12 months. 15. Participation in any investigational study that has not yet reached its primary endpoint, and for which monotherapy with ticagrelor may affect the primary outcome (as per the judgement of the investigator). 16. Patients who medicate with a potent CYP3A4 inhibitor (e.g. ketoconazole, clarithromycin, nefazodone, ritonavir and atazanavir) 17. Pregnancy or woman of childbearing potential who is not sterilized or using a medically accepted form of contraception. 18. Expected inability (by the investigator) to comply with the protocol 19. Subjects incapable to giving consent personally
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Major adverse cardiac event | within 3 months | The composite of cardiac death, spontaneous myocardial infarction or definite or probable stent thrombosis. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants with bleeding | within 12 months | Bleeding Academic Research Consortium (BARC) types 3 or 5 bleeding (time-to-event) |
| Number of Participants with stent thrombosis or target vessel myocardial infarction | within 12 months | Definite or probable stent thrombosis or spontaneous target vessel myocardial infarction (time-to-event) |
| Number of Participants with myocardial infarction | within 12 months | Any spontaneous myocardial infarction (time-to-event) |
| Number of Participants that died | within 12 months | All-cause mortality (time-to-event) |
| Number of Participants with major adverse cardiac event | within 12 months. | The composite of cardiac death, spontaneous target vessel myocardial infarction or definite or probable stent thrombosis |
| Platelet reactivity | at 24 hours | Platelet reactivity as assessed by the ADP-test (multiplate). |
Countries
Sweden
Contacts
PRINCIPAL_INVESTIGATOROskar Angerås, MD, PhD
Sahlgrenska Universitetssjukhus
Outcome results
None listed