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Heart FailureEARLY-HFNCT04810806

Timing of Coronary Angiography in NSTE-ACS With ADHF

A study testing Immediate coronary angiography within 2 hours after randomization and Delayed coronary angiography after stabilization of heart failure in people with Heart Failure and Acute Coronary Syndrome, run by Chonnam National University Hospital at 1 site in South Korea.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The investigators hypothesized that immediate coronary angiography (CAG) within 2 hours after admission can reduce mortality compared to delayed CAG after stabilization of acute decompensated heart failure (ADHF) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) complicated by ADHF. Read more about this study

Who is it for?
Ages 19 years and older
Conditions the study is for
Heart Failure, Acute Coronary Syndrome
What is being tested?
Immediate coronary angiography within 2 hours after randomization and Delayed coronary angiography after stabilization of heart failure
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
316 participants
Where
1 siteSouth Korea
Study dates
1 Apr 2021to 1 Mar 2024
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 19 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age more than 18 years old
  • NSTE-ACS*
  • Pulmonary congestion or edema on chest X-ray
  • The definition of NSTE-ACS
  • Among patients with typical angina, dyspnea or chest discomfort without definite non-cardiac causes, at least 1 presentations of angina that suggest a NSTE-ACS:
  • Rest angina, which is usually more than 20 minutes in duration
Show all 9Show fewer
  • New onset angina that markedly limits physical activity
  • Increasing angina that is more frequent, longer in duration, or occurs with less exertion than previous angina
  • A 12-lead electrocardiogram should have no ST-segment elevation. Cardiac troponin may elevate (non-ST-segment elevation myocardial infarction) or not elevate (unstable angina pectoris).

Who cannot join

  • 1) Cardiogenic shock 2) Heart failure of other causes rather than NSTE-ACS 3) Terminal malignancy 4) Life expentancy < 1 year 5) Pregnancy or lactation
  • The definition of cardiogenic shock All these criteria should be met
  • Systolic blood pressure < 90 mmHg for 30 minutes, or needing inotropics or vasopressor to maintain systolic blood pressure > or = 90 mmHg
  • Pulmonary congestion on chest X-ray or increased left ventricular filling pressure by cardiac catheterization
  • At least one criteria of organ dysfunction - mental obtundation, clammy ski, ogliuria, renal dysfunction, increased level of blood lactate

Trial locations and contacts

1 site in 1 country.

South Korea1 site
  • Chonnam National University Hospital

    Gwangju

Other trials in South Korea

About this study

Official title: Immediate Versus Delayed Coronary Angiography in Patients With Non-ST-Segment Acute Coronary Syndrome With Acute Decompensated Heart Failure

The investigators hypothesized that immediate coronary angiography (CAG) within 2 hours after admission can reduce mortality compared to delayed CAG after stabilization of acute decompensated heart failure (ADHF) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) complicated by ADHF. Patients with NSTE-ACS complicated by ADHF will be randomized to immediate CAG (coronary angiography < 2 hours after randomization) or delayed CAG after stablization group by 1:1 fashion. This study is a prospective, non-blinded, randomized trial.

Read the detailed description

Study objective In this study, investigators aim to compare early coronary angiography (CAG < 2 hours after randomization) and delayed CAG after stabilization of acute decompensated heart failure (ADHF) in patients with acute non-ST-elevation acute coronary syndrome (NSTE-ACS) complicated by ADHF. This study is a prospective, non-blinded, randomized trial.

Study background An ADHF is frequently encountered in patients with NSTE-ACS. Although its incidence has been decreased during the decades, it is still high up to 8-12% at initial presentation of NSTE-ACS. Patients with NSTE-ACS complicated by ADHF is also known to be associated with worse in-hospital and long-term clinical outcomes than those without heart failure (HF). Because revascularization could reduce mortality in these patients, it should be done in all patients with NSTE-ACS with ADHF. Current guidelines recommend immediate CAG within 2 hours after admission in patients with NSTE-ACS complicated by ADHF. However, it is difficult to decide the timing of coronary angiography in these high risk patients.

Notably, the most of randomized trials about the timing of coronary angiography in NSTE-ACS excluded these high risk patients, therefore there is lack of evidence for immediate coronary angiography within 2 hours after admission in patients with NSTE-ACS complicated by ADHF.

Investigators will compare immediate CAG within 2 hours after admission and delayed CAG after stabilization of ADHF in patients with NSTE-ACS complicated by ADHF by randomized controlled trial.

Study hypothesis Immediate CAG within 2 hours after admission can reduce mortality compared to delayed CAG after stabilization of ADHF in patients with NSTE-ACS complicated by ADHF.

Being tested
Immediate coronary angiography within 2 hours after randomization, Delayed coronary angiography after stabilization of heart failure
Keywords
Heart Failure, Acute Coronary Syndrome, Non-ST-Segment Elevation Acute Coronary Syndrome, Myocardial Infarction, Coronary Disease, Cardiovascular Diseases, Heart Diseases
Medical subject headings
Heart Failure, Acute Coronary Syndrome, Myocardial Infarction, Coronary Disease, Cardiovascular Diseases, Heart Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Immediate coronary angiography within 2 hours after randomizationProcedure or surgery

    After achievement of informed consent in patients with NSTE-ACS complicated by ADHF, patients will be screened and randomized. Patients will be randomized to immediate CAG group or delayed CAG group. Immediate CAG group will receive CAG within 2 hours after randomization. Patients will receive treatment methods according to CAG results: percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) or medical therapy only by operators' discretion.

  • Delayed coronary angiography after stabilization of heart failureProcedure or surgery

    After achievement of informed consent in patients with NSTE-ACS complicated by ADHF, patients will be screened and randomized. Patients will be randomized to immediate CAG group or delayed CAG group. Delayed CAG group will receive CAG after stabilization of ADHF; improvement of symptoms and signs of heart failure. Patients will receive treatment methods according to CAG results: percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) or medical therapy only by operators' discretion.

Study groups in NCT04810806
Study groupRoleWhat they receive
Immediate coronary angiography groupExperimentalImmediate coronary angiography group will routinely receive coronary angiography within 2 hours after randomization.
Receives: Procedure: Immediate coronary angiography within 2 hours after randomization
Delayed coronary angiography groupActive comparatorDelayed coronary angiography group will receive coronary angiography during hospitalization after stabilization of symptoms and signs of heart failure.
Receives: Procedure: Delayed coronary angiography after stabilization of heart failure

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Cumulative incidence rate of all-cause death, non-fatal myocardial infarction or recurrent ischemia

    Cumulative incidence rate of all-cause death, non-fatal myocardial infarction or recurrent ischemia

    Measured: Up to 12 months

Secondary outcomes (37)
  1. Rate of all-cause death, non-fatal myocardial infarction or recurrent ischemia

    All-cause death, non-fatal myocardial infarction or recurrent ischemia during initial hospitalization

    Measured: Up to 12 months

  2. In-hospital mortality

    All-cause mortality during initial hospitalization

    Measured: Up to 12 months

  3. In-hospital cardiac mortality

    Cardiac mortality during initial hospitalization

    Measured: Up to 12 months

  4. Rate of procedural complications during coronary angiography or percutaneous coronary intervention

    Rate of procedural complications during coronary angiography or percutaneous coronary intervention during initial hospitalization

    Measured: Up to 12 months

  5. Peak level of troponin-I

    Peak level of troponin-I during initial hospitalization

    Measured: Up to 12 months

  6. Rate of recurrent ischemia

    Rate of recurrent ischemia during initial hospitalization

    Measured: Up to 12 months

  7. Rate of Non-fatal myocardial infarction

    Non-fatal myocardial infarction during initial hospitalization

    Measured: Up to 12 months

  8. Rate of stroke

    Rate of stroke during initial hospitalization

    Measured: Up to 12 months

  9. Usage rate of non-invasive positive pressure ventilation

    Usage rate of non-invasive positive pressure ventilation during initial hospitalization

    Measured: Up to 12 months

  10. Usage rate of mechanical ventilator

    Usage rate of mechanical ventilator during initial hospitalization

    Measured: Up to 12 months

  11. Usage rate of renal replacement therapy

    Usage rate of renal replacement therapy during initial hospitalization

    Measured: Up to 12 months

  12. Usage rate of mechanical circulatory support

    Usage rate of mechanical circulatory support during initial hospitalization

    Measured: Up to 12 months

  13. Rate of acute kidney injury

    Rate of acute kidney injury during initial hospitalization

    Measured: Up to 12 months

  14. Rate of stent thrombosis

    Rate of stent thrombosis during initial hospitalization

    Measured: Up to 12 months

  15. Rate of major bleeding

    Rate of major bleeding during initial hospitalization (BARC classificiation 3-5)

    Measured: Up to 12 months

  16. Duration of initial hospitalization

    Duration of initial hospitalization (days)

    Measured: Up to 12 months

  17. Cumulative incidence rate of all-cause death, non-fatal myocardial infarction or recurrent ischemia

    Cumulative incidence rate of all-cause death, non-fatal myocardial infarction or recurrent ischemia

    Measured: Up to 1 month

  18. Cumulative incidence rate of all-cause death

    Cumulative incidence rate of all-cause death

    Measured: Up to 1 month

  19. Cumulative incidence rate of cardiac death

    Cumulative incidence rate of cardiac death

    Measured: Up to 1 month

  20. Cumulative incidence rate of rehospitalization due to heart failure

    Cumulative incidence rate of rehospitalization due to heart failure

    Measured: Up to 1 month

  21. Cumulative incidence rate of cardiogenic shock

    Cumulative incidence rate of cardiogenic shock

    Measured: Up to 1 month

  22. Cumulative incidence rate of stroke

    Cumulative incidence rate of stroke

    Measured: Up to 1 month

  23. Cumulative incidence rate of stent thrombosis

    Cumulative incidence rate of stent thrombosis

    Measured: Up to 1 month

  24. Cumulative incidence rate of major bleeding (BARC classification 3-5)

    Cumulative incidence rate of major bleeding (BARC classification 3-5)

    Measured: Up to 1 month

  25. Cumulative incidence rate of recurrent ischemia

    Cumulative incidence rate of recurrent ischemia

    Measured: Up to 1 month

  26. Cumulative incidence rate of non-fatal myocardial infarction

    Cumulative incidence rate of non-fatal myocardial infarction

    Measured: Up to 1 month

  27. Cumulative incidence rate of all unplanned revascularization

    Cumulative incidence rate of all unplanned revascularization

    Measured: Up to 1 month

  28. Cumulative incidence rate of all-cause death

    Cumulative incidence rate of all-cause death

    Measured: Up to 12 months

  29. Cumulative incidence rate of cardiac death

    Cumulative incidence rate of cardiac death

    Measured: Up to 12 months

  30. Cumulative incidence rate of rehospitalization due to heart failure

    Cumulative incidence rate of rehospitalization due to heart failure

    Measured: Up to 12 months

  31. Cumulative incidence rate of cardiogenic shock

    Cumulative incidence rate of cardiogenic shock

    Measured: Up to 12 months

  32. Cumulative incidence rate of stroke

    Cumulative incidence rate of stroke

    Measured: Up to 12 months

  33. Cumulative incidence rate of stent thrombosis

    Cumulative incidence rate of stent thrombosis

    Measured: Up to 12 months

  34. Cumulative incidence rate of major bleeding (BARC classification 3-5)

    Cumulative incidence rate of major bleeding (BARC classification 3-5)

    Measured: Up to 12 months

  35. Cumulative incidence rate of recurrent ischemia

    Cumulative incidence rate of recurrent ischemia

    Measured: Up to 12 months

  36. Cumulative incidence rate of non-fatal myocardial infarction

    Cumulative incidence rate of non-fatal myocardial infarction

    Measured: Up to 12 months

  37. Cumulative incidence rate of all unplanned revascularization

    Cumulative incidence rate of all unplanned revascularization

    Measured: Up to 12 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 Mar 2021
  2. Study start1 Apr 2021
  3. Primary completion1 Mar 2024
  4. Study completion1 Mar 2024

Why it stopped: Slow enrollment

Resources

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
316 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04810806
Sponsor's protocol ID
CNUH-2020-396
Acronym
EARLY-HF
Status last verified
Feb 2024
First submitted
14 Mar 2021
Last updated
1 Mar 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Lim Y, Park S, Joo D, Lee YK, Oh S, Lee SH, Ahn JH, Hyun DY, Cho KH, Sim DS, Hong YJ, Kim JH, Ahn Y, Kim MC. Immediate versus delayed coronary angiography in patients with non-ST segment elevation acute coronary syndrome complicated with acute decompensated heart failure: The EARLY-HF randomized clinical trial. Cardiovasc Revasc Med. 2026 Feb;83:32-39. doi: 10.1016/j.carrev.2025.09.016. Epub 2025 Oct 6.

    PubMed 41073186

Questions about this trial

What is this clinical trial studying?

A study testing Immediate coronary angiography within 2 hours after randomization and Delayed coronary angiography after stabilization of heart failure in people with Heart Failure and Acute Coronary Syndrome, run by Chonnam National University Hospital at 1 site in South Korea.

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 9 inclusion and 5 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 1 Mar 2024. 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 South Korea. 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: Slow 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?

Cumulative incidence rate of all-cause death, non-fatal myocardial infarction or recurrent ischemia (time frame: Up to 12 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 NCT04810806, which also lists 1 linked publication.

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 1 Mar 2024.

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