Myocardial IschemiaNCT00665028
Perioperative Ischemia Reduction Study (PROSE) Pilot
An observational study of Myocardial Ischemia, run by Ottawa Hospital Research Institute at 1 site in Canada.
Trial summary
After surgery, patients who have cardiogram changes consistent with a lack of oxygen to the heart muscles, also known as myocardial ischemia, have been found to have 9 times the chance of having an event such as a heart attack during the subsequent 30 days. Read more about this study
- Who is it for?
- Ages 55 years and older
- Conditions the study is for
- Myocardial Ischemia
- How many people
- 30 participants
- Where
- 1 siteCanada
- Study dates
- Nov 2007to Apr 2012
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 55 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: Elective non-cardiac surgical procedure
Who may be able to join
- Age 55 years
- RCRI Class; 3 (i.e. 2 factors)
- Elective non-cardiac surgical procedure
- Expected to stay in hospital 2 days
Who cannot join
- Atrial fibrillation
- Left bundle branch block (LBBB)
- Pacemaker dependency
- Digoxin
- CABG / PCI within 5 years
- Low risk surgery (TURP, digit re-implantation, nerve repair, etc)
Show all 11Show fewer
- Expected ICU admission
- CO2 retention
- Refusal to transfusions
- Adverse drug reaction to NSAIDS, beta-blockers, Ca-channel blockers, statins, nitrates
- Prior enrolment in PROSE
Trial locations and contacts
1 site in 1 country.
About this study
After surgery, patients who have cardiogram changes consistent with a lack of oxygen to the heart muscles, also known as myocardial ischemia, have been found to have 9 times the chance of having an event such as a heart attack during the subsequent 30 days. It is not known if monitoring and treating ischemia will prevent events such as heart attacks. It is not known if such monitoring and treatment can be done on the regular surgical wards. In this pilot study, we hope to demonstrate that such a study is feasible, and the maintenance of blinding is possible. The primary outcomes are to show that such monitoring after surgery is possible in ≥ 95% of patients, to show that response and treatment to such ischemia in ≤ 1 hour is possible in ≥ 90% of patients, and that blinding between the standard and active treatment groups is possible for 50% ± 1 s.d.. With the pilot study data, if successful, we will be applying for peer-reviewed funding for a full study.
Read the detailed description
Perioperative myocardial ischemia has been studied in the pre-, intra-, and postoperative periods. The intraoperative incidence is similar to the preoperative period but the postoperative incidence is doubled that of the preoperative period. These results have two implications: postoperative myocardial ischemia cannot be predicted by preoperative ambulatory ECG monitoring since only half of those are seen preoperatively; the postoperative period is when significant myocardial ischemia occurs.
The role of myocardial ischemia, especially prolonged ischemia, in perioperative myocardial infarction (PMI) has been recognized by a number of investigators. In the presence of postoperative myocardial ischemia, the relative risk of a postoperative cardiac event was 16 in one study and the odds ratio for an ischemic cardiac event was 9.2 in another. Using 12-lead continuous monitoring, one study found that all PMI were preceded by myocardial ischemia.
Ambulatory ECG in the postoperative period has been well reported in the past. Recently, Landesberg reported the sensitivity and specificity of lead placements to detect myocardial ischemia in the postoperative period. Lead combinations were compared with continuous 12-lead ECG in 185 consecutive patients. Combining two precordial leads, the sensitivity for detecting ischemia was 97.4% for V3 + V5; 92.1% for V4 + V5; and for infarction was 100% for V3 + V5 or V4 + V5.
We believe that the pathogenesis of PMI is multifactorial. Apart from the coronary anatomy and the vulnerable plaque, stress hormones and catecholamine surges in the perioperative period are well reported. Stress increases systolic BP, which is a major determinant of LV wall tension, and hence, myocardial oxygen demand. The oxygen cost of "pressure work" is greater than "volume work", with the area-under-the-curve for LV pressure closely correlating with myocardial oxygen demand. Hypercoagulable state has also been implicated in PMI.
With so many possible pathogenesis, it is our belief therefore that postoperative myocardial ischemia may be one of the final pathways just before postoperative ischemic cardiac complications. This is especially so when all PMI were preceded by myocardial ischemia in one study. With potentially multiple pathogenesis, it is unknown if postoperative myocardial ischemia is amenable to treatment. It is, however, our belief that postoperative myocardial ischemia can be aborted using existing treatment modalities. The implication is that the reduction of postoperative myocardial ischemia may reduce the incidence of postoperative ischemic cardiac complications, including PMI.
Current standard of care does not include telemetry or real-time ST monitoring on surgical patients. Traditional telemetry would impede low-risk patients in their postoperative recovery by limiting them to their beds. In the context of real-time monitoring for ST changes in low-risk patients, the cost of traditional telemetry with nursing may also be prohibitive. We propose a novel technological application, transmitting wireless ST segment monitoring and alarms to a Blackberry. This will alert the research team to verify via "full disclosure" on the ST monitor and respond directly. SpaceLab, GlobeStar, and Research in Motion (RIM) have developed the hardware and software respectively. We currently have written assurances and support from SpaceLab, GlobeStar, and RIM to conduct a pilot study for this novel application (see attached). We therefore propose a pilot study to determine the feasibility of wireless ST-segment monitoring and its treatment in post-surgical patients.
- Conditions
- Myocardial Ischemia
- Keywords
- Anesthesia, Postoperative myocardial ischemia, ST monitoring
- Medical subject headings
- Myocardial Ischemia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| 1 | Postoperative myocardial ischemia |
What is being measured
The primary outcome is the main question the study is designed to answer.
Perioperative Ischemia Reduction Study Pilot (PROSE) & (PROSE 2)
Observational study on feasibility of remote ECG ST monitoring on a wireless system.
Measured: 12 months
Feasibility of remote wireless ECG ST monitoring
To study the feasibility of real-time remote wireless ECG ST monitoring through wireless infrastructure of the hospital
Measured: 24 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted23 Apr 2008 (estimated)
- Study startNov 2007
- Primary completionApr 2012
- Study completionApr 2012
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Myocardial IschemiaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 30 participants (actual)
Sponsor and investigators
- Lead sponsor
- Ottawa Hospital Research Institute
- Sponsor type
- University, hospital or other
- Collaborators
- SpaceLab, Research in Motion, Globestar
- Responsible party
- Sponsor
- Investigators
- H Yang, MD, Principal investigator, Ottawa Hospital Research Institute
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00665028
- Sponsor's protocol ID
- 2007246-01H
- Status last verified
- Jan 2015
- First submitted
- 21 Apr 2008
- Last updated
- 8 Jan 2015
- Results posted
- No
- Data monitoring committee
- No
Study at a glance
From the registry record, last updated by the sponsor on 8 Jan 2015. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Perioperative Ischemia Reduction Study (PROSE) Pilot
- ClinicalTrials.gov ID
- NCT00665028
- Acronym / sponsor ID
- 2007246-01H
- Conditions
- Myocardial Ischemia
- Keywords
- Anesthesia, Postoperative myocardial ischemia, ST monitoring
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 30 participants (actual)
- Lead sponsor
- Ottawa Hospital Research InstituteUniversity, hospital or other
- Collaborators
- SpaceLab, Research in Motion, Globestar
- Study start
- Nov 2007
- Primary completion
- Apr 2012 (actual)
- Study completion
- Apr 2012 (actual)
- First posted
- 23 Apr 2008 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
After surgery, patients who have cardiogram changes consistent with a lack of oxygen to the heart muscles, also known as myocardial ischemia, have been found to have 9 times the chance of having an event such as a heart attack during the subsequent 30 days. It is not known if monitoring and treating ischemia will prevent events such as heart attacks. It is not known if such monitoring and treatment can be done on the regular surgical wards. In this pilot study, we hope to demonstrate that such a study is feasible, and the maintenance of blinding is possible. The primary outcomes are to show that such monitoring after surgery is possible in ≥ 95% of patients, to show that response and treatment to such ischemia in ≤ 1 hour is possible in ≥ 90% of patients, and that blinding between the standard and active treatment groups is possible for 50% ± 1 s.d.. With the pilot study data, if successful, we will be applying for peer-reviewed funding for a full study.
Detailed description
Perioperative myocardial ischemia has been studied in the pre-, intra-, and postoperative periods. The intraoperative incidence is similar to the preoperative period but the postoperative incidence is doubled that of the preoperative period. These results have two implications: postoperative myocardial ischemia cannot be predicted by preoperative ambulatory ECG monitoring since only half of those are seen preoperatively; the postoperative period is when significant myocardial ischemia occurs.
The role of myocardial ischemia, especially prolonged ischemia, in perioperative myocardial infarction (PMI) has been recognized by a number of investigators. In the presence of postoperative myocardial ischemia, the relative risk of a postoperative cardiac event was 16 in one study and the odds ratio for an ischemic cardiac event was 9.2 in another. Using 12-lead continuous monitoring, one study found that all PMI were preceded by myocardial ischemia.
Ambulatory ECG in the postoperative period has been well reported in the past. Recently, Landesberg reported the sensitivity and specificity of lead placements to detect myocardial ischemia in the postoperative period. Lead combinations were compared with continuous 12-lead ECG in 185 consecutive patients. Combining two precordial leads, the sensitivity for detecting ischemia was 97.4% for V3 + V5; 92.1% for V4 + V5; and for infarction was 100% for V3 + V5 or V4 + V5.
We believe that the pathogenesis of PMI is multifactorial. Apart from the coronary anatomy and the vulnerable plaque, stress hormones and catecholamine surges in the perioperative period are well reported. Stress increases systolic BP, which is a major determinant of LV wall tension, and hence, myocardial oxygen demand. The oxygen cost of "pressure work" is greater than "volume work", with the area-under-the-curve for LV pressure closely correlating with myocardial oxygen demand. Hypercoagulable state has also been implicated in PMI.
With so many possible pathogenesis, it is our belief therefore that postoperative myocardial ischemia may be one of the final pathways just before postoperative ischemic cardiac complications. This is especially so when all PMI were preceded by myocardial ischemia in one study. With potentially multiple pathogenesis, it is unknown if postoperative myocardial ischemia is amenable to treatment. It is, however, our belief that postoperative myocardial ischemia can be aborted using existing treatment modalities. The implication is that the reduction of postoperative myocardial ischemia may reduce the incidence of postoperative ischemic cardiac complications, including PMI.
Current standard of care does not include telemetry or real-time ST monitoring on surgical patients. Traditional telemetry would impede low-risk patients in their postoperative recovery by limiting them to their beds. In the context of real-time monitoring for ST changes in low-risk patients, the cost of traditional telemetry with nursing may also be prohibitive. We propose a novel technological application, transmitting wireless ST segment monitoring and alarms to a Blackberry. This will alert the research team to verify via "full disclosure" on the ST monitor and respond directly. SpaceLab, GlobeStar, and Research in Motion (RIM) have developed the hardware and software respectively. We currently have written assurances and support from SpaceLab, GlobeStar, and RIM to conduct a pilot study for this novel application (see attached). We therefore propose a pilot study to determine the feasibility of wireless ST-segment monitoring and its treatment in post-surgical patients.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| 1 | – | –Postoperative myocardial ischemia |
Who may qualify
- Ages
- 55 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Elective non-cardiac surgical procedure
Key inclusion criteria (4 listed)
- Age 55 years
- RCRI Class; 3 (i.e. 2 factors)
- Elective non-cardiac surgical procedure
- Expected to stay in hospital 2 days
Key exclusion criteria (11 listed)
- Atrial fibrillation
- Left bundle branch block (LBBB)
- Pacemaker dependency
- Digoxin
- CABG / PCI within 5 years
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Perioperative Ischemia Reduction Study Pilot (PROSE) & (PROSE 2)
Time frame: 12 months
Observational study on feasibility of remote ECG ST monitoring on a wireless system.
Feasibility of remote wireless ECG ST monitoring
Time frame: 24 months
To study the feasibility of real-time remote wireless ECG ST monitoring through wireless infrastructure of the hospital
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 8 Jan 2015.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
H Yang, MD principal investigator
Ottawa Hospital Research Institute
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Myocardial Ischemia, run by Ottawa Hospital Research Institute at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 8 Jan 2015. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Perioperative Ischemia Reduction Study Pilot (PROSE) & (PROSE 2) (time frame: 12 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Jan 2015.