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Angina Pectoris; AngiospasticVAPNCT06176391

SCS for Vasospastic Angina Vasospastic Angina Pectoris - a Prospective Study

A study testing Spinal Cord Stimulation in people with Angina Pectoris; Angiospastic, run by Amsterdam UMC, location VUmc.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

According to the 2020 Dutch guideline on chest pain (AP) without obstructive coronary artery disease, 70% of female and 30% of male patients undergoing a coronary angiogram (CAG), have no obstructive coronary artery disease.In the majority of patients the complaints are based on vascular dysfunction, including… Read more about this study

Who is it for?
Ages 18 to 90 years
Conditions the study is for
Angina Pectoris; Angiospastic
What is being tested?
Spinal Cord Stimulation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
10 participants
Where
No sites listed yet
Study dates
2 Jan 2024to 31 Dec 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 18 to 90 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • VSA is objectivated with a provocative acetylcholine test
  • mentally competent and able to fill in the questionnaires
  • refractory VSA defined as disabling chest pain with a maximum tolerated dosage of calcium antagonists, long acting nitrates, angiotensin converting enzyme inhibitors for a minimum of three months
  • absence of obstructive coronary artery disease evident in a main coronary artery (diameter stenosis<50%, Instant Flow Reserve (IFR) >0.89, or Fractional Flow reserve (FFR) >0.80)
  • able to use the remote control of the SCS system

Who cannot join

  • inability to visit the outpatient department for the follow-up visits
  • unable to provide informed consent
  • myocardial infarction in the previous three months
  • procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), nor instability of the clinical signs and symptoms of refractory angina in the previous three months
  • implanted pacemaker or implantable cardioverter-defibrillator (ICD) incompatible with SCS
  • indication for ongoing anticoagulation therapy
  • pregnant women and those who are breastfeeding

Trial locations and contacts

No sites are listed yet.

Matthanja Bieze, MD, PhD contact

00-31-20-5662303

m.bieze@msterdamumc.nl

About this study

Official title: Spinal Cord Stimulation for Vasospastic Angina Pectoris - a Prospective Study

According to the 2020 Dutch guideline on chest pain (AP) without obstructive coronary artery disease, 70% of female and 30% of male patients undergoing a coronary angiogram (CAG), have no obstructive coronary artery disease.In the majority of patients the complaints are based on vascular dysfunction, including epicardial vascular spasms. For patients who are refractory to drug treatment, spinal cord stimulation (SCS) can be a treatment option. SCS is used for the treatment of refractory neuropathic and ischaemic pain. In recent studies the use of SCS is proven for refractory angina pectoris, but the group with refractory vasospastic angina pectoris (rVSA) predominantly seen in women with invalidating impairment of quality of life, is overlooked, as no evidence of obstruction is found at CAG. With this pilot study the investigators hypothesize that SCS is effective in reducing the number and intensity of angina attacks, reducing nitrate use, reducing inhospital treatment and ER presentations, thereby reducing medical costs, and above all, increasing quality of life.

Read the detailed description

Rationale:

Of the patients undergoing a coronary angiogram because of chest pain (AP), 67% of female and 33% of male patients have no obstructive coronary artery disease. In the majority of patients (59-89%) the complaints are based on vascular dysfunction, including epicardial vascular spasms (EVS). For patients who are refractory to drug treatment, spinal cord stimulation (SCS) can be a treatment option. SCS is used for the treatment of refractory neuropathic and ischaemic pain. In recent studies the use of SCS is proven effective for refractory angina pectoris, but the group with refractory vasospastic angina pectoris (rVSA), predominantly seen in women with invalidating impairment of quality of life, is overlooked, as no evidence of obstruction is found at CAG. With this study the investigators hypothesize that SCS is effective in reducing the number and intensity of angina attacks, reducing nitrate use, reducing inhospital treatment and ER presentations, thereby reducing medical costs, and above all, increasing quality of life.

Objective: the main objective of this study is to evaluate the clinical effects of SCS on the number and intensity of VSA attacks. Secondary objective is to objectivate the effects of SCS on coronary spasms during the provocative acetylcholine test, and assess medical costs, patient satisfaction and quality of life.

Study design: prospective study in two phases. Phase 1: evaluation of clinical effectiveness. Phase 2: evaluation of SCS on vascular spasms during acetylcholine provocation test.

Study population: 10 patients with refractory AP due to epicardial vascular spasms.

Intervention: implantation with a SCS device with one or two lead(s) in the epidural space of T1 to T4, active electrodes depending on mapping of the painfull area, under local anesthesia and sedation. Acetylcholine provocation test during coronary angiogram at 6 months.

Main study parameters/endpoints: primary endpoint is the Seattle Angina Questionnaire (SAQ) at month 1 and 3. Secundary endpoints are presentation at ER, estimated medical costs, and patient satisfaction measured on a 11 point Numeric Rating Scale and quality of life with the EQ5D at month 3, compared to baseline. Endpoints of the acetylcholine test are changes in coronary flow and coronary diameter compared to baseline.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: SCS is proven to be safe for neuropathic and ischaemic pain and is widely used in clinical practice. With the positive results of an ongoing clinical trial for refractory coronary angina, the investigators estimate the efficacy of SCS to be around 80-90% in reducing VSA attacks with 50% after 3 months and therefore very effective in otherwise refractory drug treatment regiments. Furthermore, baseline study parameters will be extracted from the routine questionnaires and during visits to the outpatient clinic.

Only in patients who specifically consent to it, an additional acetylcholine test 6 months after SCS implantation during coronary angiography (CAG) is performed. This is an additional coronary angiogram procedure under local anesthesia which potentially provokes VSA. Done by experienced personal this is a safe test with a complication risk of 0-0.7% for severe cardiac complications, comparable to coronary angiogram with functional flow reserve measurement.

A potential benefit for the participants is that SCS results in reduction of VSA attacks, reduction of nitrate use, less presentation at an ER, an improved quality of life, and acceptation as standard treatment.

Being tested
Spinal Cord Stimulation
Keywords
ANOCA (Angina with Non-Obstructive Coronary Artery disease), Spinal Cord Stimulation, Angina Pectoris
Medical subject headings
Angina Pectoris

What participants receive

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

  • Spinal Cord StimulationDevice

    Also called Dorsal Column Stimulation

    Single lead placement in the posterior thoracic epidural space (T1-T4) connected to a subcutaneous battery

Study groups in NCT06176391
Study groupRoleWhat they receive
singleOtherSubjects are their own control
Receives: Device: Spinal Cord Stimulation

What is being measured

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

  1. Seattle Angina Questionnaire (SAQ)

    For patients with coronary artery disease, the Seattle Angina Questionnaire (SAQ) has emerged as the most commonly used measure of disease-specific health status to quantify patients' symptoms of angina and the extent to which their angina affects their functioning and quality of life.

    Scores of 0 to 30 translate to daily angina, 31 to 60 to weekly angina, 61 to 99 to monthly angina, and 100 to no angina.

    Measured: baseline (before implant) - 1 month after implant - 3 months after implant

Secondary outcomes (4)
  1. Euroquol Quality of Life questionnaire (EQ5D-5L)

    The EQ-5D-5L is a self-assessed, health related, quality of life questionnaire. The scale measures quality of life on a 5-component scale including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.

    The maximum score of 1 indicates the best health state, by contrast with the scores of individual questions, where higher scores indicate more severe or frequent problems. In addition, there is a visual analogue scale (VAS) to indicate the general health status with 100 indicating the best health status.

    Measured: baseline (before implant) -1 month after implant - 3 months after implant

  2. Patient satisfaction - Numeric Rating Scale (NRS) 0-10

    11-point Likert-type scale

    Measured: 1 month and 3 months after implant

  3. Complications and side effects

    Related to SCS

    Measured: through study completion, an average of 6 months

  4. Acetylcholine provocation test during coronary angiogram

    Test to objectivate coronary spasms (compared to baseline)

    Measured: 6 months after implant

Timeline

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

  1. First posted19 Dec 2023
  2. Study start2 Jan 2024 (estimated)
  3. Primary completion31 Oct 2024 (estimated)
  4. Study completion31 Dec 2024 (estimated)

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
Not applicable
Intervention model
Single group
Model description
Prospective pilot study
Masking
None (open label)
Enrolment
10 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06176391
Sponsor's protocol ID
NL79947.018.21
Acronym
VAP
Status last verified
Dec 2023
First submitted
26 Nov 2023
Last updated
19 Dec 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
Yes: In progress

Publications

  • Deer TR, Mekhail N, Provenzano D, Pope J, Krames E, Leong M, Levy RM, Abejon D, Buchser E, Burton A, Buvanendran A, Candido K, Caraway D, Cousins M, DeJongste M, Diwan S, Eldabe S, Gatzinsky K, Foreman RD, Hayek S, Kim P, Kinfe T, Kloth D, Kumar K, Rizvi S, Lad SP, Liem L, Linderoth B, Mackey S, McDowell G, McRoberts P, Poree L, Prager J, Raso L, Rauck R, Russo M, Simpson B, Slavin K, Staats P, Stanton-Hicks M, Verrills P, Wellington J, Williams K, North R; Neuromodulation Appropriateness Consensus Committee. The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: the Neuromodulation Appropriateness Consensus Committee. Neuromodulation. 2014 Aug;17(6):515-50; discussion 550. doi: 10.1111/ner.12208.

    PubMed 25112889
  • Murphy DF, Giles KE. Dorsal column stimulation for pain relief from intractable angina pectoris. Pain. 1987 Mar;28(3):365-368. doi: 10.1016/0304-3959(87)90070-4.

    PubMed 3494978
  • Mannheimer C, Eliasson T, Augustinsson LE, Blomstrand C, Emanuelsson H, Larsson S, Norrsell H, Hjalmarsson A. Electrical stimulation versus coronary artery bypass surgery in severe angina pectoris: the ESBY study. Circulation. 1998 Mar 31;97(12):1157-63. doi: 10.1161/01.cir.97.12.1157.

    PubMed 9537342
  • Mobilia G, Zuin G, Zanco P, Di Pede F, Pinato G, Neri G, Cargnel S, Raviele A, Ferlin G, Buchberger R. [Effects of spinal cord stimulation on regional myocardial blood flow in patients with refractory angina. A positron emission tomography study]. G Ital Cardiol. 1998 Oct;28(10):1113-9. Italian.

    PubMed 9834863
  • Dejongste MJ. Efficacy, safety and mechanisms of spinal cord stimulation used as an additional therapy for patients suffering from chronic refractory angina pectoris. Neuromodulation. 1999 Jul;2(3):188-92. doi: 10.1046/j.1525-1403.1999.00188.x. No abstract available.

    PubMed 22151207
  • Lopshire JC, Zhou X, Dusa C, Ueyama T, Rosenberger J, Courtney N, Ujhelyi M, Mullen T, Das M, Zipes DP. Spinal cord stimulation improves ventricular function and reduces ventricular arrhythmias in a canine postinfarction heart failure model. Circulation. 2009 Jul 28;120(4):286-94. doi: 10.1161/CIRCULATIONAHA.108.812412. Epub 2009 Jul 13.

    PubMed 19597055
  • Liu Y, Yue WS, Liao SY, Zhang Y, Au KW, Shuto C, Hata C, Park E, Chen P, Siu CW, Tse HF. Thoracic spinal cord stimulation improves cardiac contractile function and myocardial oxygen consumption in a porcine model of ischemic heart failure. J Cardiovasc Electrophysiol. 2012 May;23(5):534-40. doi: 10.1111/j.1540-8167.2011.02230.x. Epub 2011 Dec 8.

    PubMed 22151312
  • Taylor RS, De Vries J, Buchser E, Dejongste MJ. Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomised controlled trials. BMC Cardiovasc Disord. 2009 Mar 25;9:13. doi: 10.1186/1471-2261-9-13.

    PubMed 19320999
  • Andrell P, Yu W, Gersbach P, Gillberg L, Pehrsson K, Hardy I, Stahle A, Andersen C, Mannheimer C. Long-term effects of spinal cord stimulation on angina symptoms and quality of life in patients with refractory angina pectoris--results from the European Angina Registry Link Study (EARL). Heart. 2010 Jul;96(14):1132-6. doi: 10.1136/hrt.2009.177188. Epub 2010 May 18.

    PubMed 20483898
  • McNab D, Khan SN, Sharples LD, Ryan JY, Freeman C, Caine N, Tait S, Hardy I, Schofield PM. An open label, single-centre, randomized trial of spinal cord stimulation vs. percutaneous myocardial laser revascularization in patients with refractory angina pectoris: the SPiRiT trial. Eur Heart J. 2006 May;27(9):1048-53. doi: 10.1093/eurheartj/ehi827. Epub 2006 Mar 22.

    PubMed 16554313
  • Vervaat FE, van der Gaag A, van Suijlekom H, Botman CJ, Teeuwen K, Wijnbergen I. Improvement in quality of life and angina pectoris: 1-year follow-up of patients with refractory angina pectoris and spinal cord stimulation. Neth Heart J. 2020 Sep;28(9):478-484. doi: 10.1007/s12471-020-01422-0.

    PubMed 32430654
  • Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB Jr, Fihn SD, Fraker TD Jr, Gardin JM, O'Rourke RA, Pasternak RC, Williams SV, Gibbons RJ, Alpert JS, Antman EM, Hiratzka LF, Fuster V, Faxon DP, Gregoratos G, Jacobs AK, Smith SC Jr; American College of Cardiology; American Heart Association Task Force on Practice Guidelines. Committee on the Management of Patients With Chronic Stable Angina. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation. 2003 Jan 7;107(1):149-58. doi: 10.1161/01.cir.0000047041.66447.29. No abstract available.

    PubMed 12515758
  • Suwaidi JA, Hamasaki S, Higano ST, Nishimura RA, Holmes DR Jr, Lerman A. Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation. 2000 Mar 7;101(9):948-54. doi: 10.1161/01.cir.101.9.948.

    PubMed 10704159
  • Deer T, Slavin KV, Amirdelfan K, North RB, Burton AW, Yearwood TL, Tavel E, Staats P, Falowski S, Pope J, Justiz R, Fabi AY, Taghva A, Paicius R, Houden T, Wilson D. Success Using Neuromodulation With BURST (SUNBURST) Study: Results From a Prospective, Randomized Controlled Trial Using a Novel Burst Waveform. Neuromodulation. 2018 Jan;21(1):56-66. doi: 10.1111/ner.12698. Epub 2017 Sep 29.

    PubMed 28961366
  • Chakravarthy K, Kent AR, Raza A, Xing F, Kinfe TM. Burst Spinal Cord Stimulation: Review of Preclinical Studies and Comments on Clinical Outcomes. Neuromodulation. 2018 Jul;21(5):431-439. doi: 10.1111/ner.12756. Epub 2018 Feb 12.

    PubMed 29431275

Questions about this trial

What is this clinical trial studying?

A study testing Spinal Cord Stimulation in people with Angina Pectoris; Angiospastic, run by Amsterdam UMC, location VUmc.

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 5 inclusion and 7 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: status not confirmed, as of the sponsor's last update on 19 Dec 2023. Status can change between updates, so confirm with the study contact before making plans.

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?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Frank Wille, MD (00-31-20-5662303, f.wille@msterdamumc.nl), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Seattle Angina Questionnaire (SAQ) (time frame: baseline (before implant) - 1 month after implant - 3 months after implant). 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 NCT06176391, 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 19 Dec 2023.

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