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Coronary Artery DiseaseNCT05387902

Short-term Outcomes of Elective High-risk PCI With Extracorporeal Membrane Oxygenation Support: a Single-centre Registry

An observational study of Coronary Artery Disease, run by Robert Jan van Geuns at 1 site in Netherlands.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Background Revascularization of complex coronary artery disease, including multivessel coronary artery disease, left main stenosis, bifurcation stenosis and chronic total occlusions (CTO) can be performed by Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft (CABG), according to current… Read more about this study

Who is it for?
Any age
Conditions the study is for
Coronary Artery Disease
What is being tested?
Extracorporeal Membrane Oxygenation
Type of treatment
Medical device
How many people
25 participants
Where
1 siteNetherlands
Study dates
3 Feb 2022to 22 Mar 2022
How long will I take part?
60 Days
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 Any age
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Study population: All patients older than 18 years who are undergoing a high-risk PCI with VA-ECMO support, indicated by HeartTeam consensus based on patient and lesion characteristics, as described by the expert consensus. If a non-elective PCI with VA-ECMO support, primarily applied for cardiogenic shock or ECPR, is performed, patients are not eligible for inclusion.

Who may be able to join

  • Patients older than 18 years, who underwent high-risk PCI with VA-ECMO support.
  • The use of mechanical circulatory support (MCS) is indicated by HeartTeam based on patient and lesion characteristics described in the expert consensus on the use of MCS Devices for high-risk PCI.

Who cannot join

  • Non-elective PCI with VA-ECMO support, primarily applied for cardiogenic shock or ECPR.

Trial locations and contacts

1 site in 1 country.

Netherlands1 site
  • Radboud University Medical Centre

    Nijmegen

Other trials in Netherlands

About this study

Background Revascularization of complex coronary artery disease, including multivessel coronary artery disease, left main stenosis, bifurcation stenosis and chronic total occlusions (CTO) can be performed by Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft (CABG), according to current guidelines.[1] In order to decide whether to revascularize by either CABG or PCI, patient characteristics, the presence of comorbidities, including diabetes, and coronary lesion complexity (e.g. SYNTAX) should be taken into consideration. Because of the ageing population with a higher incidence of comorbidities and higher surgical risk scores, high-risk PCI in complex coronary disease with high risk for periprocedural cardiogenic shock is increasingly performed.[2, 3] Mechanical Circulatory Support (MCS) devices for elective high-risk PCI can provide hemodynamic support, preventing hemodynamic failure during PCI. Several studies are performed using Intra-Aortic Balloon Pump (IABP) and co-axial left cardiac support device (Impella device (Abiomed, Danvers, USA)), showing no clear benefits in patients with high-risk PCI.[4-6] Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a recent addition to mechanical support options, providing more extensive hemodynamic support in patients with potential or ongoing failure of circulation. This concept is already demonstrated in the setting of Extracorporeal Cardiopulmonary Resuscitation (ECPR).[7, 8] ECMO has the additional benefits of right ventricular unloading and blood oxygenation as opposed to IABP and Impella.[9] Our experience with fully percutaneous VA-ECMO in cardiogenic shock and for ECPR combined with the experience for Transcatheter Aortic Valve Replacement (TAVR) with local anaesthesia and mild sedation resulted in the selection of VA-ECMO as our preferred method in high risk PCI. Studies investigating the use of VA-ECMO support during high-risk PCI are however limited.[10-13]

Objective The aim of this study is to provide additional data concerning the short-term outcomes of elective high-risk PCI with VA-ECMO in a single PCI centre.

Read more

Methods Design We will perform a single-centre, retrospective registry, using data collected from medical records of included patients.

Inclusion criteria

  • Patients older than 18 years, who underwent high-risk PCI with VA-ECMO support.
  • The use of mechanical circulatory support (MCS) is indicated by HeartTeam based on patient and lesion characteristics described in the expert consensus on the use of MCS Devices for high-risk PCI. [14]

Exclusion criteria

  • Non-elective PCI with VA-ECMO support, primarily applied for cardiogenic shock or ECPR.

Study Procedures All patients older than 18 years who underwent high-risk PCI with VA-ECMO support will be included in the registry. Baseline patient and angiographic characteristics, ECMO characteristics and short-term outcomes, described in the paragraph 'Study Endpoints and Definitions' will be collected from medical records.

The Dutch Act on Medical Research involving Human Subjects (WMO) does not apply to this study, because of the retrospective design of the study using only medical records and consequently patients are not subjected to additional procedures. Therefore, no written informed consent will be obtained from patients or legal representatives as well.

Data Collection All data will be collected in a cloud-based electronic case report form (eCRF, Castor Electronic Data Capture), which will be developed and managed by investigators in the Radboudumc. Only members of the study team will have access to the patient eCRFs and will be allowed to enter data in the system. The study team exists of the investigators mentioned earlier. The study team will collect the data from medical records and enter the data in Castor. All patient data will be encoded. Only the investigators involved will have access to the patient identification key.

Study Endpoints and Definitions Successful revascularization is defined as final residual stenosis <50% with a TIMI flow grade 3, achieved in at least one of the target vessels. Procedural success is defined as angiographic success without the occurrence of peri-procedural MACE, including death and myocardial infarction (MI). Additionally, MACE will be assessed during hospital stay and within 60-days follow-up after discharge and defined as a composite of death, MI, Target Vessel Revascularization (TVR) by PCI or CABG and clinical bleeding, assessed by the Bleeding Academic Research Consortium (BARC) scale. Bleeding complications of type 2 and higher are included.

Being tested
Extracorporeal Membrane Oxygenation
Keywords
Percutaneous Coronary Intervention, Extracorporeal Membrane Oxygenation
Medical subject headings
Coronary Artery Disease

What participants receive

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

  • Extracorporeal Membrane OxygenationDevice

    Patients with high-risk PCI receive mechanical circulatory support with ECMO.

Study groups in NCT05387902
Study groupRoleWhat they receive
ECMOPatients receiving hemodynamic support with ECMO during high-risk PCI
Receives: Device: Extracorporeal Membrane Oxygenation
ECMO StandbyPatients with ECMO standby during high-risk PCI

What is being measured

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

  1. Major Adverse Cardiac Events

    Composite of death, MI, Target Vessel Revascularization (TVR) by PCI or CABG and clinical bleeding, assessed by the Bleeding Academic Research Consortium (BARC) scale

    Measured: from PCI procedure up to hospital discharge, an average of 7 days

  2. Major Adverse Cardiac Events

    Composite of death, MI, Target Vessel Revascularization (TVR) by PCI or CABG

    Measured: within 60 days after discharge

Secondary outcomes (2)
  1. Succesful Revascularization

    Final residual stenosis <50% with a TIMI flow grade 3, achieved in at least one of the target vessels

    Measured: During PCI Procedure

  2. Procedural Success

    Angiographic success without the occurrence of peri-procedural MACE, including death and myocardial infarction (MI)

    Measured: During PCI Procedure

Timeline

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

  1. First posted24 May 2022
  2. Study start3 Feb 2022
  3. Primary completion8 Feb 2022
  4. Study completion22 Mar 2022

Resources

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
Other
Enrolment
25 participants (actual)
Target duration
60 Days
IDs, dates and publications
ClinicalTrials.gov ID
NCT05387902
Sponsor's protocol ID
113382
Status last verified
May 2022
First submitted
16 May 2022
Last updated
24 May 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Upon request, data supporting the findings and conclusion of this study will be made available by the PI.

Publications

  • Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Juni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO; ESC Scientific Document Group. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019 Jan 7;40(2):87-165. doi: 10.1093/eurheartj/ehy394. No abstract available.

    PubMed 30165437
  • Valgimigli M, Tebaldi M, Borghesi M, Vranckx P, Campo G, Tumscitz C, Cangiano E, Minarelli M, Scalone A, Cavazza C, Marchesini J, Parrinello G; PRODIGY Investigators. Two-year outcomes after first- or second-generation drug-eluting or bare-metal stent implantation in all-comer patients undergoing percutaneous coronary intervention: a pre-specified analysis from the PRODIGY study (PROlonging Dual Antiplatelet Treatment After Grading stent-induced Intimal hyperplasia studY). JACC Cardiovasc Interv. 2014 Jan;7(1):20-8. doi: 10.1016/j.jcin.2013.09.008. Epub 2013 Dec 11.

    PubMed 24332420
  • Waldo SW, Secemsky EA, O'Brien C, Kennedy KF, Pomerantsev E, Sundt TM 3rd, McNulty EJ, Scirica BM, Yeh RW. Surgical ineligibility and mortality among patients with unprotected left main or multivessel coronary artery disease undergoing percutaneous coronary intervention. Circulation. 2014 Dec 23;130(25):2295-301. doi: 10.1161/CIRCULATIONAHA.114.011541. Epub 2014 Nov 12.

    PubMed 25391519
  • Perera D, Stables R, Thomas M, Booth J, Pitt M, Blackman D, de Belder A, Redwood S; BCIS-1 Investigators. Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial. JAMA. 2010 Aug 25;304(8):867-74. doi: 10.1001/jama.2010.1190.

    PubMed 20736470
  • Perera D, Stables R, Clayton T, De Silva K, Lumley M, Clack L, Thomas M, Redwood S; BCIS-1 Investigators. Long-term mortality data from the balloon pump-assisted coronary intervention study (BCIS-1): a randomized, controlled trial of elective balloon counterpulsation during high-risk percutaneous coronary intervention. Circulation. 2013 Jan 15;127(2):207-12. doi: 10.1161/CIRCULATIONAHA.112.132209. Epub 2012 Dec 6.

    PubMed 23224207
  • Henriques JP, Remmelink M, Baan J Jr, van der Schaaf RJ, Vis MM, Koch KT, Scholten EW, de Mol BA, Tijssen JG, Piek JJ, de Winter RJ. Safety and feasibility of elective high-risk percutaneous coronary intervention procedures with left ventricular support of the Impella Recover LP 2.5. Am J Cardiol. 2006 Apr 1;97(7):990-2. doi: 10.1016/j.amjcard.2005.10.037. Epub 2006 Feb 13.

    PubMed 16563902
  • Bougouin W, Dumas F, Lamhaut L, Marijon E, Carli P, Combes A, Pirracchio R, Aissaoui N, Karam N, Deye N, Sideris G, Beganton F, Jost D, Cariou A, Jouven X; Sudden Death Expertise Center investigators. Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study. Eur Heart J. 2020 Jun 1;41(21):1961-1971. doi: 10.1093/eurheartj/ehz753.

    PubMed 31670793
  • Yannopoulos D, Bartos J, Raveendran G, Walser E, Connett J, Murray TA, Collins G, Zhang L, Kalra R, Kosmopoulos M, John R, Shaffer A, Frascone RJ, Wesley K, Conterato M, Biros M, Tolar J, Aufderheide TP. Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial. Lancet. 2020 Dec 5;396(10265):1807-1816. doi: 10.1016/S0140-6736(20)32338-2. Epub 2020 Nov 13.

    PubMed 33197396
  • Spiro J, Doshi SN. Use of left ventricular support devices during acute coronary syndrome and percutaneous coronary intervention. Curr Cardiol Rep. 2014 Dec;16(12):544. doi: 10.1007/s11886-014-0544-x.

    PubMed 25326728
  • Vainer J, van Ommen V, Maessen J, Geskes G, Lamerichs L, Waltenberger J. Elective high-risk percutaneous coronary interventions supported by extracorporeal life support. Am J Cardiol. 2007 Mar 15;99(6):771-3. doi: 10.1016/j.amjcard.2006.10.034. Epub 2007 Jan 22.

    PubMed 17350362
  • Shaukat A, Hryniewicz-Czeneszew K, Sun B, Mudy K, Wilson K, Tajti P, Stanberry L, Garberich R, Sandoval Y, Burke MN, Chavez I, Gossl M, Henry T, Lips D, Mooney M, Poulose A, Sorajja P, Traverse J, Wang Y, Bradley S, Brilakis ES. Outcomes of Extracorporeal Membrane Oxygenation Support for Complex High-Risk Elective Percutaneous Coronary Interventions: A Single-Center Experience and Review of the Literature. J Invasive Cardiol. 2018 Dec;30(12):456-460. doi: 10.25270/jic/18.3012.456.

    PubMed 30504514
  • van den Brink FS, Meijers TA, Hofma SH, van Boven AJ, Nap A, Vonk A, Symersky P, Sjauw KD, Knaapen P. Prophylactic veno-arterial extracorporeal membrane oxygenation in patients undergoing high-risk percutaneous coronary intervention. Neth Heart J. 2020 Mar;28(3):139-144. doi: 10.1007/s12471-019-01350-8.

    PubMed 31782108
  • Tomasello SD, Boukhris M, Ganyukov V, Galassi AR, Shukevich D, Haes B, Kochergin N, Tarasov R, Popov V, Barbarash L. Outcome of extracorporeal membrane oxygenation support for complex high-risk elective percutaneous coronary interventions: A single-center experience. Heart Lung. 2015 Jul-Aug;44(4):309-13. doi: 10.1016/j.hrtlng.2015.03.005. Epub 2015 Apr 23.

    PubMed 25913808
  • Rihal CS, Naidu SS, Givertz MM, Szeto WY, Burke JA, Kapur NK, Kern M, Garratt KN, Goldstein JA, Dimas V, Tu T; Society for Cardiovascular Angiography and Interventions (SCAI), Heart Failure Society of America (HFSA), Society of Thoracic Surgeons (STS), American Heart Association (AHA), and American College of Cardiology (ACC). 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care: Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencionista; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention. J Am Coll Cardiol. 2015 May 19;65(19):2140-1. doi: 10.1016/j.jacc.2015.02.043. Epub 2015 Apr 7. No abstract available.

    PubMed 25861962
  • Griffioen AM, Van Den Oord SCH, Van Wely MH, Swart GC, Van Wetten HB, Danse PW, Damman P, Van Royen N, Van Geuns RJM. Short-Term Outcomes of Elective High-Risk PCI with Extracorporeal Membrane Oxygenation Support: A Single-Centre Registry. J Interv Cardiol. 2022 Sep 16;2022:7245384. doi: 10.1155/2022/7245384. eCollection 2022.

    PubMed 36189196

Questions about this trial

What is this clinical trial studying?

An observational study of Coronary Artery Disease, run by Robert Jan van Geuns at 1 site in Netherlands.

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 2 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: finished, as of the sponsor's last update on 24 May 2022. 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 Netherlands. 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?

Major Adverse Cardiac Events (time frame: from PCI procedure up to hospital discharge, an average of 7 days). 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?

On the ClinicalTrials.gov record for NCT05387902, which also lists 15 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 24 May 2022.

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