Cardiovascular DiseasesCOATNCT00968383
Cardiovascular Magnetic Resonance for the Occluded Infarct-Related Artery Treatment
A study testing Beta adrenergic blockers, Platelet inhibitors and Statins in people with Cardiovascular Diseases and Heart Diseases, run by National Institute of Cardiology, Warsaw, Poland at 1 site in Poland.
Trial summary
The purpose of this study is to determine whether opening an occluded infarcted artery 3-28 days after an acute myocardial infarction in high-risk asymptomatic patients with preserved infarct zone viability improves left ventricular systolic function and volumes at 6 months follow-up. Read more about this study
- Who is it for?
- Ages 18 to 85 years
- Conditions the study is for
- Cardiovascular Diseases, Heart Diseases, Myocardial Infarction
- What is being tested?
- Beta adrenergic blockers, Platelet inhibitors and Statins
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 11 participants
- Where
- 1 sitePoland
- Study dates
- Sep 2009to Dec 2012
- Phase
- Interventional
- 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 18 to 85 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Enrollment 3-28 days after an acute myocardial infarction.
- Infarct related artery occlusion (TIMI 0 or 1).
- High risk: left ventricular ejection fraction (LVEF)<50% or LVEF>50% and proximal coronary occlusion.
- Preserved infarct zone viability (necrosis transmurality <50% in at least 4 segments out of 17 according to AHA classification).
Who cannot join
- Unstable clinical condition
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Late Percutaneous Coronary Intervention of the Occluded Infarct-Related Artery in Patients With Preserved Infarct Zone Viability Determined With Magnetic Resonance Imaging
The purpose of this study is to determine whether opening an occluded infarcted artery 3-28 days after an acute myocardial infarction in high-risk asymptomatic patients with preserved infarct zone viability improves left ventricular systolic function and volumes at 6 months follow-up. The secondary purpose is to assess the changes in myocardial tissue characteristics after late percutaneous coronary intervention (PCI).
Read the detailed description
Rapid restoration of blood flow in the infarct-related artery (IRA), one of the cornerstones of contemporary treatment of acute myocardial infarction (MI) prevents myocardial necrosis and its consequences. However, due to late presentation or failed fibrinolytic therapy up to one third of patients have persistently occluded IRA after MI.
Recently, the Occluded Artery Trial (OAT) has demonstrated that percutaneous coronary intervention (PCI) with optimal medical therapy does not reduce the frequency of major adverse events compared to optimal medical therapy alone when performed on days 3-28 post MI in stable patients. Assessment of infarct zone viability was not used as an inclusion/exclusion criterion in the main OAT trial.
Several studies confirm that patients with left ventricular systolic dysfunction and preserved myocardial viability (necrosis transmurality<50% in most segments of the infarct zone) assessed with magnetic resonance imaging benefit from revascularization.
Late opening of the occluded infarct-related artery only in patients with preserved myocardial tissue viability may lead to improvement of left ventricular volumes and function.
- Being tested
- Beta adrenergic blockers, Platelet inhibitors, Statins, ACE inhibitors and/or ARB and/or AA, PCI with stenting
- Keywords
- Acute Coronary Syndrome, Myocardial infarction, Infarct Related Artery, Percutaneous Coronary Intervention, Medical treatment, Tissue Viability, Magnetic Resonance
- Medical subject headings
- Cardiovascular Diseases, Heart Diseases, Myocardial Infarction, Heart Failure, Acute Coronary Syndrome
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Beta adrenergic blockersDrug
Participants will receive beta adrenergic blockers.
Platelet inhibitorsDrug
Participants will receive platelet inhibitors.
StatinsDrug
Participants will receive statins.
ACE inhibitors and/or ARB and/or AADrug
Participants will receive ACE inhibitors and/or ARB and/or AA
PCI with stentingProcedure or surgery
Participants will undergo percutaneous coronary intervention (PCI) and coronary stenting.
| Study group | Role | What they receive |
|---|---|---|
| Optimal medical therapy | Active comparator | Conventional medical management, including aspirin, clopidogrel, statins, beta blockers, angiotensin converting enzyme (ACE) inhibitors and/or angiotensin receptor blocker (ARB) and/or aldosterone antagonist and risk factor modification Receives: Drug: Beta adrenergic blockers; Drug: Platelet inhibitors; Drug: Statins; Drug: ACE inhibitors and/or ARB and/or AA |
| PCI with optimal medical therapy | Experimental | Conventional medical management, including aspirin, clopidogrel, statins, beta blockers, angiotensin converting enzyme (ACE) inhibitors and/or angiotensin receptor blocker (ARB) and/or aldosterone antagonist and risk factor modification plus percutaneous coronary intervention and coronary stenting Receives: Drug: Beta adrenergic blockers; Drug: Platelet inhibitors; Drug: Statins; Drug: ACE inhibitors and/or ARB and/or AA; Procedure: PCI with stenting |
What is being measured
The primary outcome is the main question the study is designed to answer.
change in systolic wall thickening (SWT)
Measured: 6 months
Secondary outcomes (5)
change in left ventricular ejection fraction (LVEF)
Measured: 6 months
change in wall motion score index (WMSI)
Measured: 6 months
change in left ventricular end-diastolic volume (LVEDV)
Measured: 6 months
change in left ventricular end-systolic volume (LVESV)
Measured: 6 months
myocardial tissue characteristics
Measured: 3-5 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted31 Aug 2009 (estimated)
- Study startSep 2009
- Primary completionDec 2012
- Study completionDec 2012
Why it stopped: The study was prematurely terminated due to low enrollment.
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for Cardiovascular DiseasesStudies 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 N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 11 participants (actual)
Sponsor and investigators
- Lead sponsor
- National Institute of Cardiology, Warsaw, Poland
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Lukasz A Malek, M.D. PhD, Principal investigator, National Institute of Cardiology, Warsaw, PolandMariusz Kruk, M.D. PhD, Study chair, National Institute of Cardiology, Warsaw, PolandMariusz Klopotowski, M.D., Study chair, National Institute of Cardiology, Warsaw, Poland
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00968383
- Sponsor's protocol ID
- 2.50/V/09
- Acronym
- COAT
- Status last verified
- May 2015
- First submitted
- 30 Jun 2009
- Last updated
- 14 May 2015
- Results posted
- No
- Data monitoring committee
- No
Publications
Hochman JS, Lamas GA, Knatterud GL, Buller CE, Dzavik V, Mark DB, Reynolds HR, White HD; Occluded Artery Trial Research Group. Design and methodology of the Occluded Artery Trial (OAT). Am Heart J. 2005 Oct;150(4):627-42. doi: 10.1016/j.ahj.2005.07.002.
PubMed 16209957Hochman JS, Lamas GA, Buller CE, Dzavik V, Reynolds HR, Abramsky SJ, Forman S, Ruzyllo W, Maggioni AP, White H, Sadowski Z, Carvalho AC, Rankin JM, Renkin JP, Steg PG, Mascette AM, Sopko G, Pfisterer ME, Leor J, Fridrich V, Mark DB, Knatterud GL; Occluded Artery Trial Investigators. Coronary intervention for persistent occlusion after myocardial infarction. N Engl J Med. 2006 Dec 7;355(23):2395-407. doi: 10.1056/NEJMoa066139. Epub 2006 Nov 14.
PubMed 17105759Malek LA, Reynolds HR, Forman SA, Vozzi C, Mancini GB, French JK, Dziarmaga M, Renkin JP, Kochman J, Lamas GA, Hochman JS. Late coronary intervention for totally occluded left anterior descending coronary arteries in stable patients after myocardial infarction: Results from the Occluded Artery Trial (OAT). Am Heart J. 2009 Apr;157(4):724-32. doi: 10.1016/j.ahj.2008.12.008.
PubMed 19332202Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med. 2000 Nov 16;343(20):1445-53. doi: 10.1056/NEJM200011163432003.
PubMed 11078769Malek LA, Silva JC, Bellenger NG, Nicolau JC, Klopotowski M, Spiewak M, Rassi CH, Lewandowski Z, Kruk M, Rochitte CE, Ruzyllo W, Witkowski A. Late percutaneous coronary intervention for an occluded infarct-related artery in patients with preserved infarct zone viability: a pooled analysis of cardiovascular magnetic resonance studies. Cardiol J. 2013;20(5):552-9. doi: 10.5603/CJ.2013.0141.
PubMed 24297771
Study at a glance
From the registry record, last updated by the sponsor on 14 May 2015. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Late Percutaneous Coronary Intervention of the Occluded Infarct-Related Artery in Patients With Preserved Infarct Zone Viability Determined With Magnetic Resonance Imaging
- ClinicalTrials.gov ID
- NCT00968383
- Acronym / sponsor ID
- COAT / 2.50/V/09
- Keywords
- Acute Coronary Syndrome, Myocardial infarction, Infarct Related Artery, Percutaneous Coronary Intervention, Medical treatment, Tissue Viability, Magnetic Resonance
- Study type
- Interventional
- Recruitment status
- TerminatedReason stopped: The study was prematurely terminated due to low enrollment.
- Enrolment
- 11 participants (actual)
- Lead sponsor
- National Institute of Cardiology, Warsaw, PolandUniversity, hospital or other
- Study start
- Sep 2009
- Primary completion
- Dec 2012 (actual)
- Study completion
- Dec 2012 (actual)
- First posted
- 31 Aug 2009 (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.
The purpose of this study is to determine whether opening an occluded infarcted artery 3-28 days after an acute myocardial infarction in high-risk asymptomatic patients with preserved infarct zone viability improves left ventricular systolic function and volumes at 6 months follow-up. The secondary purpose is to assess the changes in myocardial tissue characteristics after late percutaneous coronary intervention (PCI).
Detailed description
Rapid restoration of blood flow in the infarct-related artery (IRA), one of the cornerstones of contemporary treatment of acute myocardial infarction (MI) prevents myocardial necrosis and its consequences. However, due to late presentation or failed fibrinolytic therapy up to one third of patients have persistently occluded IRA after MI.
Recently, the Occluded Artery Trial (OAT) has demonstrated that percutaneous coronary intervention (PCI) with optimal medical therapy does not reduce the frequency of major adverse events compared to optimal medical therapy alone when performed on days 3-28 post MI in stable patients. Assessment of infarct zone viability was not used as an inclusion/exclusion criterion in the main OAT trial.
Several studies confirm that patients with left ventricular systolic dysfunction and preserved myocardial viability (necrosis transmurality<50% in most segments of the infarct zone) assessed with magnetic resonance imaging benefit from revascularization.
Late opening of the occluded infarct-related artery only in patients with preserved myocardial tissue viability may lead to improvement of left ventricular volumes and function.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Optimal medical therapy | Active comparator | Drug: Beta adrenergic blockers, Drug: Platelet inhibitors, Drug: Statins, Drug: ACE inhibitors and/or ARB and/or AAConventional medical management, including aspirin, clopidogrel, statins, beta blockers, angiotensin converting enzyme (ACE) inhibitors and/or angiotensin receptor blocker (ARB) and/or aldosterone antagonist and risk factor modification |
| PCI with optimal medical therapy | Experimental | Drug: Beta adrenergic blockers, Drug: Platelet inhibitors, Drug: Statins, Drug: ACE inhibitors and/or ARB and/or AA, Procedure: PCI with stentingConventional medical management, including aspirin, clopidogrel, statins, beta blockers, angiotensin converting enzyme (ACE) inhibitors and/or angiotensin receptor blocker (ARB) and/or aldosterone antagonist and risk factor modification plus percutaneous coronary intervention and coronary stenting |
Who may qualify
- Ages
- 18 to 85 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Enrollment 3-28 days after an acute myocardial infarction.
- Infarct related artery occlusion (TIMI 0 or 1).
- High risk: left ventricular ejection fraction (LVEF)<50% or LVEF>50% and proximal coronary occlusion.
- Preserved infarct zone viability (necrosis transmurality <50% in at least 4 segments out of 17 according to AHA classification).
Key exclusion criteria (1 listed)
- Unstable clinical condition
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 |
|---|---|---|
| Beta adrenergic blockersParticipants will receive beta adrenergic blockers. | Drug | Optimal medical therapy, PCI with optimal medical therapy |
| Platelet inhibitorsParticipants will receive platelet inhibitors. | Drug | Optimal medical therapy, PCI with optimal medical therapy |
| StatinsParticipants will receive statins. | Drug | Optimal medical therapy, PCI with optimal medical therapy |
| ACE inhibitors and/or ARB and/or AAParticipants will receive ACE inhibitors and/or ARB and/or AA | Drug | Optimal medical therapy, PCI with optimal medical therapy |
| PCI with stentingParticipants will undergo percutaneous coronary intervention (PCI) and coronary stenting. | Procedure or surgery | PCI with optimal medical therapy |
Primary outcome
change in systolic wall thickening (SWT)
Time frame: 6 months
5 secondary outcomes
change in left ventricular ejection fraction (LVEF)
Time frame: 6 months
change in wall motion score index (WMSI)
Time frame: 6 months
change in left ventricular end-diastolic volume (LVEDV)
Time frame: 6 months
change in left ventricular end-systolic volume (LVESV)
Time frame: 6 months
myocardial tissue characteristics
Time frame: 3-5 days
Results and safety
The study was stopped early (reason given: The study was prematurely terminated due to low enrollment.). Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 14 May 2015.
- Background: PubMed 16209957Hochman JS, Lamas GA, Knatterud GL, Buller CE, Dzavik V, Mark DB, Reynolds HR, White HD; Occluded Artery Trial Research Group. Design and methodology of the Occluded Artery Trial (OAT). Am Heart J. 2005 Oct;150(4):627-42. doi: 10.1016/j.ahj.2005.07.002.
- Background: PubMed 17105759Hochman JS, Lamas GA, Buller CE, Dzavik V, Reynolds HR, Abramsky SJ, Forman S, Ruzyllo W, Maggioni AP, White H, Sadowski Z, Carvalho AC, Rankin JM, Renkin JP, Steg PG, Mascette AM, Sopko G, Pfisterer ME, Leor J, Fridrich V, Mark DB, Knatterud GL; Occluded Artery Trial Investigators. Coronary intervention for persistent occlusion after myocardial infarction. N Engl J Med. 2006 Dec 7;355(23):2395-407. doi: 10.1056/NEJMoa066139. Epub 2006 Nov 14.
- Background: PubMed 19332202Malek LA, Reynolds HR, Forman SA, Vozzi C, Mancini GB, French JK, Dziarmaga M, Renkin JP, Kochman J, Lamas GA, Hochman JS. Late coronary intervention for totally occluded left anterior descending coronary arteries in stable patients after myocardial infarction: Results from the Occluded Artery Trial (OAT). Am Heart J. 2009 Apr;157(4):724-32. doi: 10.1016/j.ahj.2008.12.008.
- Background: PubMed 11078769Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med. 2000 Nov 16;343(20):1445-53. doi: 10.1056/NEJM200011163432003.
- Derived from this study: PubMed 24297771Malek LA, Silva JC, Bellenger NG, Nicolau JC, Klopotowski M, Spiewak M, Rassi CH, Lewandowski Z, Kruk M, Rochitte CE, Ruzyllo W, Witkowski A. Late percutaneous coronary intervention for an occluded infarct-related artery in patients with preserved infarct zone viability: a pooled analysis of cardiovascular magnetic resonance studies. Cardiol J. 2013;20(5):552-9. doi: 10.5603/CJ.2013.0141.
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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.
Lukasz A Malek, M.D. PhD principal investigator
National Institute of Cardiology, Warsaw, Poland
Mariusz Kruk, M.D. PhD study chair
National Institute of Cardiology, Warsaw, Poland
Mariusz Klopotowski, M.D. study chair
National Institute of Cardiology, Warsaw, Poland
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Beta adrenergic blockers, Platelet inhibitors and Statins in people with Cardiovascular Diseases and Heart Diseases, run by National Institute of Cardiology, Warsaw, Poland at 1 site in Poland.
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 1 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: stopped early, as of the sponsor's last update on 14 May 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 Poland. 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 was stopped early (reason given: The study was prematurely terminated due to low enrollment.). Results are not available in the source record.
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?
change in systolic wall thickening (SWT) (time frame: 6 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT00968383, which also lists 5 linked publications.
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 14 May 2015.