Coronary Artery DiseasePhase 4NCT00954707
CYPRESS - CYPHER for Evaluating Sustained Safety
A Phase 4 study testing Clopidogrel & Aspirin, Prasugrel & Aspirin in people with Coronary Artery Disease, run by Cordis US Corp. at 1 site in United States.
Trial summary
CYPRESS: A Prospective,Randomized,Multi-Center,Double-Blind Trial to Assess the Effectiveness and Safety of Different Durations of Dual Anti-Platelet Therapy (DAPT) in Subjects Undergoing Percutaneous Coronary Intervention with the CYPHER® Sirolimus-eluting Coronary Stent (CYPHER® Stent) Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Coronary Artery Disease
- What is being tested?
- Clopidogrel & Aspirin, Prasugrel & Aspirin
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 2,509 participants
- Where
- 1 siteUnited States
- Study dates
- Aug 2009to Mar 2016
- Phase
- Phase 4
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
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 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
DAPT Group - Inclusion Criteria:
Phase I: Enrollment Inclusion Criteria
Subjects must meet ALL of the following inclusion criteria to be enrolled in the study:
- The subject must be 18 years of age.
- Subjects undergoing percutaneous intervention with stent deployment
- Subjects without known contraindication to dual antiplatelet therapy for at least 30 months after enrollment and stent implantation.
- The subject or Legally Authorized Representative has consented to participate and has authorized the collection and release of his/her medical information by signing the "Patient Informed Consent Form" that is approved by the Institutional Review Board or Independent Ethics Committee. The informed consent will be valid for the duration of the trial or until the subject withdraws.
DAPT Group Phase II: Randomization Inclusion Criterion at 12 months
Subjects must meet the following criterion to be eligible for randomization in the study:
- Subject is 12 Month Clear
DAPT Group - Exclusion Criteria:
Phase I: Enrollment Exclusion Criteria
Subjects will be excluded if ANY of the following exclusion criteria apply:
- Index procedure requiring use of a stent with a nominal diameter < 2.25 mm or > 3.5 mm.
- Pregnant women.
- Planned (at time of enrollment) surgery necessitating discontinuation of antiplatelet therapy within the 30 months following enrollment.
- Current medical condition with a life expectancy of less than 3 years.
- Concurrent enrollment in another device or drug study where the primary endpoint has not been reached or the device/drug might affect major endpoint outcomes in either Phase I or Phase II of the study.
- The subject may only be enrolled in the study once.
- Subjects on warfarin or similar anticoagulant therapy.
- Subjects with hypersensitivity or allergies to one of the drugs or components indicated in the Instructions for Use for the device implanted.
- Subjects unable to give informed consent.
- Subject treated with both DES and BMS during the index procedure.
DAPT Group Phase II: Randomization Exclusion Criteria at 12 months
Subjects will be excluded from randomization if any of the following criteria are met:
- Pregnant women.
- Subject switched thienopyridine type within 6 months prior to randomization
- Percutaneous coronary interventions or cardiac surgery between 6 weeks post index procedure and randomization.
- Planned surgery necessitating discontinuation of antiplatelet therapy within the 21 months following randomization.
- Current medical condition with a life expectancy of less than 3 years.
- Subjects on subsequent warfarin or similar anticoagulant therapy.
- Subjects who do not receive any CYPHER® Stent during the index procedure.
Non-DAPT Group
The following inclusion and exclusion criteria are for the Non-DAPT subjects. These criteria will be used to determine if the subject meets the near on-label definition
Non-DAPT Group - Inclusion Criteria:
Subjects must meet ALL of the following criteria to be enrolled in this study:
- The subject must be ≥18 years of age
- Index procedure requiring use of a stent with a nominal diameter 2.25mm to 3.5mm
- Lesion Length ≤ 34mm
- Up to 2 lesions in up to 2 vessels (2 in one vessel or 1 in each of 2 vessels)
- Ejection fraction > 30%
- Target lesion stenosis is >50% and <100% (visual estimate)
- Female of childbearing potential must have a negative pregnancy test within 10 days prior to enrollment
- The subject or Legally Authorized Representative has consented to participate and has authorized the collection and release of his/her medical information by signing the "Patient Informed Consent Form"
Non-DAPT Group - Exclusion criteria
And must NOT meet any of the following exclusion criteria:
- Target Lesion includes Bifurcations with side branch diameter >2.5mm
- Patient with excessive calcified/angulated lesion that is not suitable for stenting in the Investigator's opinion
- Restenotic Target Lesion previously treated with a stent
- Greater than 2 overlapping stents used to treat target lesion.
- Target Lesion within an unprotected Left Main (LM) with ≥50% stenosis
- Target Lesion within a coronary bypass graft (e.g., saphenous vein or arterial graft)
- Chronic (> 3 months) Total Occlusion (CTO) Lesions, TIMI grade 0 or 1 in the target lesion
- ST segment Elevation Myocardial Infarction (STEMI) within 30 days or non-STEMI within 72 hours
- Renal insufficiency (creatinine >2.5 mg) or dialysis dependent
- Lesion with visible clot
- Patient with prior brachytherapy
- Documented left ventricular ejection fraction is ≤30%
- Pretreatment with devices other than conventional balloon angioplasty
- Recipient of heart transplant
- Subject with a life expectancy less than 1 year
- Known allergies to the following: aspirin, all commercially available anti-platelet drugs heparin, stainless steel, contrast agent (that cannot be managed medically), or sirolimus (that cannot be managed medically);
- Any significant medical condition which, in the Investigator's opinion, may interfere with the subject's optimal participation in the study;
- Currently participating in an investigational drug or device study that has either not completed the primary endpoint where the prior study drug/device might affect this study's primary endpoint
- In the Investigator's opinion, the lesion is not suitable for stenting.
- Known bleeding or hypercoagulable disorder;
- Known or suspected active infection at the time of the study procedures;
- Subject is known to be pregnant
- Subject is a prisoner, mentally incompetent, and/or alcohol or drug abuser;
- Planned (at the time of enrollment) surgery necessitating discontinuation of anti-platelet therapy within the twelve (12) months following enrollment.
Trial locations and contacts
1 site in 1 country.
United States1 site
University Hospitals, Case Medical Center (Cleveland)
Cleveland, Ohio, 44106
About this study
Official title: A Prospective, Randomized, Multi-Center, Double-Blind Trial to Assess the Effectiveness and Safety of Different Durations of Dual Anti-Platelet Therapy (DAPT) in Subjects Undergoing Percutaneous Coronary Intervention With the CYPHER® Sirolimus-eluting Coronary Stent (CYPHER® Stent)
CYPRESS: A Prospective,Randomized,Multi-Center,Double-Blind Trial to Assess the Effectiveness and Safety of Different Durations of Dual Anti-Platelet Therapy (DAPT) in Subjects Undergoing Percutaneous Coronary Intervention with the CYPHER® Sirolimus-eluting Coronary Stent (CYPHER® Stent)
Read the detailed description
During Phase I (non-randomized phase) of this study, the primary objective is to assess the rate of target lesion failure in subjects implanted with the CYPHER® stent and receiving dual antiplatelet therapy for 12 months.
During Phase II (randomized phase) of this study, the primary objective is to assess safety (major and minor bleeding), MACCE, and ST rates in subjects treated with dual antiplatelet therapy for 12 or 30 months following CYPHER® stent implantation.
*Subjects treated with the CYPHER® 2.25mm stent will be followed through 60 months.
**The last 500 patients enrolled will not be eligible for randomization.
- Conditions
- Coronary Artery Disease
- Being tested
- Clopidogrel & Aspirin, Prasugrel & Aspirin, Placebo & Aspirin
- Keywords
- Atherosclerosis
- Medical subject headings
- Coronary Artery Disease, Atherosclerosis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Clopidogrel & Aspirin, Prasugrel & AspirinDrug
This population consists of subjects enrolled in the study who are free from death, MI, stroke, repeat coronary revascularization, major bleeding, and ST 12 months after stent implantation and who are compliant with 12 months of dual antiplatelet therapy following stent implantation and who are subsequently randomized to receive 18 months of thienopyridine treatment in addition to aspirin.
Placebo & AspirinDrug
This population consists of subjects enrolled in the study who are free from death, MI, stroke, repeat coronary revascularization, major bleeding, and ST 12 months after stent implantation and who are compliant with 12 months of dual antiplatelet therapy following stent implantation and who are subsequently randomized to receive 18 months of placebo treatment in addition to aspirin.
| Study group | Role | What they receive |
|---|---|---|
| 12m DAPT Group | Placebo comparator | Not described Receives: Drug: Placebo & Aspirin |
| 30m DAPT Group | Active comparator | Not described Receives: Drug: Clopidogrel & Aspirin, Prasugrel & Aspirin |
What is being measured
The primary outcome is the main question the study is designed to answer.
Phase I: the Rate of Target Lesion Failure (TLF)
Target lesion failure (TLF) is defined as clinically-driven target lesion revascularization, target vessel myocardial infarction, or cardiac death that could not be clearly attributed to a vessel other than the target vessel at 12 months.
Measured: 12 months
Secondary outcomes (12)
Rate of Device Success
A study device success is defined as achievement of a final residual diameter stenosis of < 50% (by QCA), using the assigned device only. If QCA is not available, the visual estimate of diameter stenosis is used.
Measured: From post- procedure to hospital discharge, up to 39 days
Rate of Lesion Success
Lesion success is defined as the attainment of < 50% residual stenosis (by Quantitative coronary angiography (QCA)) using any percutaneous method.
Measured: From post- procedure to hospital discharge, up to 39 days
Rate of Procedure Success
Procedure success is defined as the achievement of a final diameter stenosis of < 50% (by QCA) using any percutaneous method, without the occurrence of death, Myocardial infarction (MI), or repeat coronary revascularization of the target lesion during the hospital stay.
Measured: From post- procedure to hospital discharge, up to 39 days
Rate of Clinically-driven Target Lesion Revascularization (TVR)
Defined as any "clinically-driven" repeat percutaneous intervention of the target lesion or bypass surgery of the target vessel. Clinically-driven revascularizations are those in which the subject has a positive functional study, ischemic ECG changes at rest in a distribution consistent with the target vessel, or ischemic symptoms, and an in-lesion diameter stenosis ≥50% by QCA.
Measured: 12 Months
Rate of Clinically Driven Target Vessel Revascularization (TVR)
Defined as any clinically driven repeat percutaneous intervention of the target vessel or bypass surgery of the target vessel. Clinically-driven revascularizations are those in which the subject has a positive functional study, ischemic ECG changes at rest in a distribution consistent with the target vessel, or ischemic symptoms, and an in-lesion diameter stenosis ≥50% by QCA.
Measured: 12 months
Rate of Target Vessel Failure (TVF)
Defined as target vessel revascularization, recurrent infarction, or cardiac death that could not be clearly attributed to a vessel other than the target vessel.
Measured: 12 Months
Rate of Major Adverse Cardiac Events (MACE)
MACE includes Death, myocardial infarction, emergent bypass surgery, or target lesion revascularization at 12 months
Measured: 12 Months
Rate of Protocol Defined Stent Thrombosis (ST)
Protocol defined ST includes early and late ST. Early thrombosis is defined as composite thirty-day ischemic endpoint including death, Q-wave myocardial infarction, or subabrupt closure requiring revascularization. Late thrombosis is defined as myocardial infarction occurring > 30 days after the index procedure and attributable to the target vessel with angiographic documentation (site reported or by qualitative coronary angiography) of thrombus or total occlusion at the target site and freedom from an interim revascularization of the target vessel.
Measured: 12 Months
Rate of Academic Research Consortium (ARC) Defined Stent Thrombosis (ST)
ARC defined ST classifies ST by type - definite, probable, possible; by timing - acute, sub-acute, late, very late. Definite includes angiographic or pathologic confirmation; probable includes Any unexplained death within the first 30 days or Any MI (related to documented acute ischemia and without another obvious cause) in the territory of the stent; Possible includes Any unexplained death > 30 days. Acute includes those ≤ 24 hours post procedure; sub-acute includes those > 24 hours to ≤ 30 days post procedure; and late includes those > 30 days to ≤ 1 year post procedure; and very late includes those > 1 year post procedure.
Measured: 12 Months
Rate of Protocol Defined Major Bleeding Complications
Defined by the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) classification, including severe and moderate bleeding combined.
Measured: 12 Months
Rate of Cardiac Death
Include all deaths due to cardiac causes.
Measured: 12 Months
Rate of Non-cardiac Death
Include all deaths due to non-cardiac causes.
Measured: 12 Months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted7 Aug 2009 (estimated)
- Study startAug 2009
- Primary completionJan 2012
- Study completionMar 2016 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Other trials for Coronary Artery DiseaseStudies 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
- Interventional
- Phase
- Phase 4
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind
- Who is masked
- Participant, Investigator, Outcomes assessor
- Enrolment
- 2,509 participants (actual)
Sponsor and investigators
- Lead sponsor
- Cordis US Corp.
- Sponsor type
- Industry (pharma, biotech, devices)
- Responsible party
- Sponsor
- Investigators
- Daniel Simon, M.D., Principal investigator, University Hospitals, Case Medical Center (Cleveland)David Kandzari, M.D., Principal investigator, Piedmont Hospital, Atlanta, GA
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00954707
- Sponsor's protocol ID
- P09-6301
- Status last verified
- Jan 2014
- First submitted
- 6 Aug 2009
- Last updated
- 7 Feb 2014
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
Study at a glance
From the registry record, last updated by the sponsor on 7 Feb 2014. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Prospective, Randomized, Multi-Center, Double-Blind Trial to Assess the Effectiveness and Safety of Different Durations of Dual Anti-Platelet Therapy (DAPT) in Subjects Undergoing Percutaneous Coronary Intervention With the CYPHER® Sirolimus-eluting Coronary Stent (CYPHER® Stent)
- ClinicalTrials.gov ID
- NCT00954707
- Acronym / sponsor ID
- P09-6301
- Conditions
- Coronary Artery Disease
- Keywords
- Atherosclerosis
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 2,509 participants (actual)
- Lead sponsor
- Cordis US Corp.Industry (pharma, biotech, devices)
- Study start
- Aug 2009
- Primary completion
- Jan 2012 (actual)
- Study completion
- Mar 2016 (estimated)
- First posted
- 7 Aug 2009 (estimated)
- Results
- Posted 9 Oct 2013
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
CYPRESS: A Prospective,Randomized,Multi-Center,Double-Blind Trial to Assess the Effectiveness and Safety of Different Durations of Dual Anti-Platelet Therapy (DAPT) in Subjects Undergoing Percutaneous Coronary Intervention with the CYPHER® Sirolimus-eluting Coronary Stent (CYPHER® Stent)
Detailed description
During Phase I (non-randomized phase) of this study, the primary objective is to assess the rate of target lesion failure in subjects implanted with the CYPHER® stent and receiving dual antiplatelet therapy for 12 months.
During Phase II (randomized phase) of this study, the primary objective is to assess safety (major and minor bleeding), MACCE, and ST rates in subjects treated with dual antiplatelet therapy for 12 or 30 months following CYPHER® stent implantation.
*Subjects treated with the CYPHER® 2.25mm stent will be followed through 60 months.
**The last 500 patients enrolled will not be eligible for randomization.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| 12m DAPT Group | Placebo comparator | Drug: Placebo & Aspirin |
| 30m DAPT Group | Active comparator | Drug: Clopidogrel & Aspirin, Prasugrel & Aspirin |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Clopidogrel & Aspirin, Prasugrel & AspirinThis population consists of subjects enrolled in the study who are free from death, MI, stroke, repeat coronary revascularization, major bleeding, and ST 12 months after stent implantation and who are compliant with 12 months of dual antiplatelet therapy following stent implantation and who are subsequently randomized to receive 18 months of thienopyridine treatment in addition to aspirin. | Drug | 30m DAPT Group |
| Placebo & AspirinThis population consists of subjects enrolled in the study who are free from death, MI, stroke, repeat coronary revascularization, major bleeding, and ST 12 months after stent implantation and who are compliant with 12 months of dual antiplatelet therapy following stent implantation and who are subsequently randomized to receive 18 months of placebo treatment in addition to aspirin. | Drug | 12m DAPT Group |
Primary outcome
Phase I: the Rate of Target Lesion Failure (TLF)
Time frame: 12 months
Target lesion failure (TLF) is defined as clinically-driven target lesion revascularization, target vessel myocardial infarction, or cardiac death that could not be clearly attributed to a vessel other than the target vessel at 12 months.
12 secondary outcomes
Rate of Device Success
Time frame: From post- procedure to hospital discharge, up to 39 days
Rate of Lesion Success
Time frame: From post- procedure to hospital discharge, up to 39 days
Rate of Procedure Success
Time frame: From post- procedure to hospital discharge, up to 39 days
Rate of Clinically-driven Target Lesion Revascularization (TVR)
Time frame: 12 Months
Rate of Clinically Driven Target Vessel Revascularization (TVR)
Time frame: 12 months
Rate of Target Vessel Failure (TVF)
Time frame: 12 Months
Rate of Major Adverse Cardiac Events (MACE)
Time frame: 12 Months
Rate of Protocol Defined Stent Thrombosis (ST)
Time frame: 12 Months
Rate of Academic Research Consortium (ARC) Defined Stent Thrombosis (ST)
Time frame: 12 Months
Rate of Protocol Defined Major Bleeding Complications
Time frame: 12 Months
Rate of Cardiac Death
Time frame: 12 Months
Rate of Non-cardiac Death
Time frame: 12 Months
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 7 Feb 2014.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
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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.
Daniel Simon, M.D. principal investigator
University Hospitals, Case Medical Center (Cleveland)
David Kandzari, M.D. principal investigator
Piedmont Hospital, Atlanta, GA
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing Clopidogrel & Aspirin, Prasugrel & Aspirin in people with Coronary Artery Disease, run by Cordis US Corp. at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
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: status not confirmed, as of the sponsor's last update on 7 Feb 2014. 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 United States. 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. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 9 Oct 2013). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
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?
Phase I: the Rate of Target Lesion Failure (TLF) (time frame: 12 months). 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 7 Feb 2014.