| E.1 Medical condition or disease under investigation | 
| E.1.1 | Medical condition(s) being investigated  | 
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| MedDRA Classification | 
| E.1.2 Medical condition or disease under investigation | 
| E.1.2 | Version  | 6.1 | 
 
| E.1.2 | Level  | PT | 
 
| E.1.2 | Classification code  | 10051592 | 
 
 
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| E.1.3 | Condition being studied is a rare disease  |  No  | 
| E.2 Objective of the trial | 
| E.2.1 | Main objective of the trial  | 
| The primary objective of this study is to test the hypothesis that AZD6140 is superior to clopidogrel for the prevention of vascular events in patients with non-ST or ST elevation ACS.  The primary efficacy endpoint is the time to first occurrence of any event from the composite of death from vascular causes, MI and stroke. | 
 
 
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| E.2.2 | Secondary objectives of the trial  | 
| -The time to first occurrence of any event from the composite of death from vascular causes, MI and stroke for the subgroup of patients with intent for invasive management at randomisation  planned coronary angiography with revascularisation if indicated during the index event hospitalisation -The time to first occurrence of any event from the composite of all-cause mortality, MI, and stroke -The time to first occurrence of any event from the composite of death from vascular causes, MI  including silent MI by electrocardiogram  ECG  , stroke, severe recurrent cardiac ischaemia, recurrent cardiac ischaemia, transient ischaemic attack  TIA  and other arterial thrombotic events -The time to first occurrence of each component of the primary composite efficacy endpoint individually in the order of MI, death from vascular causes and then stroke  -The time to occurrence of all-cause mortality -The other components of the secondary composite efficacy endpoints | 
 
 
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| E.2.3 | Trial contains a sub-study  |  Information not present in EudraCT  | 
| E.3 | Principal inclusion criteria  | 
| Index event of non-ST or ST segment elevation ACS. The patient should be hospitalised for chest pain and potential ACS and the onset of the most recent cardiac ischaemic symptoms of the index event must occur within the 24 hours before randomisation and be documented by cardiac ischaemic symptomsa of   8805;10 minutes duration at rest and    Persistent ST segment elevationc   8805;1mm  0.1 mV  in 2 or more contiguous leads and primary PCI planned   or  New or presumed new left bundle branch block  LBBB  and primary PCI planned  or  Cardiac ischaemic symptomsa of   8805;10 minutes duration at restb and at least 2 of the following criteria    i ST segment changes on ECG indicative of ischaemia   Either  ST segment depressiond   8805;1mm  0.1mV  in 2 or more contiguous leads  or  Transient ST segment elevationc   8805;1 mm  0.1 mV  in 2 or more contiguous leads   ii Positive biomarker evidence of myocardial necrosis   Either   Troponin T or I greater than the laboratory upper normal limite on at least one occasion in association with the index clinical event  ie, any elevated troponin level   or  CK-MB, preferably CK-MB mass, greater than the laboratory upper normal limite on at least one occasion in association with the index clinical event   iii  Having at least one of the following risk factors   Aged 60 or over  Previous MI or CABG  Known multi-vessel coronary artery disease  CAD   50  or more stenosis in 2 or more vessels   Previous ischaemic stroke, TIA  hospital based diagnosis , carotid stenosis  50  or more  or cerebral revascularisation   Diabetes mellitus  Peripheral arterial disease  intermittent claudication with prior objective confirmation, previous revascularisation or ankle-brachial index less than 0.9   Chronic renal dysfunction  creatinine clearance calculated by Cockcroft Gault equation is less than 60 mL/min .  Provision of signed informed consent form.  Male or female aged at least 18 years   Females of child-bearing potential  ie, females who are not chemically or surgically sterilised or females who are not post-menopause  must have a negative urine or blood pregnancy test at enrolment and be willing to use 2 methods of reliable contraception, one of which must be a barrier method | 
 
 
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| E.4 | Principal exclusion criteria | 
| Any of the following is regarded as a criterion for exclusion from the study   Contraindication or other reason that clopidogrel or AZD6140 should not be administered  eg, hypersensitivity, active bleeding, moderate or severe liver disease, history of previous intracranial bleed, GI bleed within the past 6 months, major surgery within 30 days   Index event is an acute complication of PCI   Patient has undergone PCI after the index event and before the first dose of study treatment   Oral anticoagulation therapy that cannot be stopped  ie, patient requires chronic therapy   Fibrinolytic therapy in the 24 hours prior to randomisation, or planned fibrinolytic treatment following randomisation  eg, for STEMI or PE   Increased risk of bradycardic events  e.g. no pacemaker and known sick sinus syndrome, second degree A-V block, third degree A-V block or previous documented syncope suspected to be due to bradycardia . The DSMB will review the Holter data in this study to assess the need to continue with this exclusion.  Patient requires dialysis  Platelet count less than 100 x 109/L   Haemoglobin  Hb  level less than 100 g/L   Participation in another investigational drug or device study in the last 30 days  Pregnancy or lactation   Concomitant oral or intravenous therapy  see examples below  with strong CYP3A inhibitors, CYP3A substrates with narrow therapeutic indices, or strong CYP3A inducers which cannot be stopped for the course of the study   Strong inhibitors  ketoconazole, itraconazole, voriconazole, telithromycin, clarithromycin, nefazadone, ritonavir, saquinavir, nelfinavir, indinavir, atanazavir, over 1 litre daily of grapefruit juice.   Substrates with narrow therapeutic index  cyclosporine, quinidine.   Strong inducers  rifampin/rifampicin, phenytoin, carbamazepine.  Any other condition which in the opinion of the investigator, may either put the patient at risk or influence the result of the study  eg, cardiogenic shock or severe haemodynamic instability, active cancer, risk for non-compliance, risk for being lost to follow up   Involvement in the planning and conduct of the study  applies to both AstraZeneca staff or staff at the study site   Previous enrolment or randomisation of treatment in the present study. | 
 
 
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| E.5 End points | 
| E.5.1 | Primary end point(s) | 
| The time to first occurrence of any event from the composite of death from vascular causes, MI and stroke.  The primary safety endpoint is the time to first occurrence of any total major  bleeding event. | 
 
 
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| E.6 and E.7 Scope of the trial | 
| E.6 | Scope of the trial | 
| E.6.1 | Diagnosis |  No  | 
| E.6.2 | Prophylaxis |  No  | 
| E.6.3 | Therapy |  Yes  | 
| E.6.4 | Safety |  Yes  | 
| E.6.5 | Efficacy |  Yes  | 
| E.6.6 | Pharmacokinetic |  Yes  | 
| E.6.7 | Pharmacodynamic |  No  | 
| E.6.8 | Bioequivalence |  Information not present in EudraCT  | 
| E.6.9 | Dose response |  No  | 
| E.6.10 | Pharmacogenetic |  Information not present in EudraCT  | 
| E.6.11 | Pharmacogenomic |  No  | 
| E.6.12 | Pharmacoeconomic |  Yes  | 
| E.6.13 | Others |  Information not present in EudraCT  | 
| E.7 | Trial type and phase | 
| E.7.1 | Human pharmacology (Phase I) |  No  | 
| E.7.1.1 | First administration to humans |  No  | 
| E.7.1.2 | Bioequivalence study |  No  | 
| E.7.1.3 | Other |  No  | 
| E.7.1.3.1 | Other trial type description |  | 
| E.7.2 | Therapeutic exploratory (Phase II) |  No  | 
| E.7.3 | Therapeutic confirmatory (Phase III) |  Yes  | 
| E.7.4 | Therapeutic use (Phase IV) |  No  | 
| E.8 Design of the trial | 
| E.8.1 | Controlled |  Yes  | 
| E.8.1.1 | Randomised |  Yes  | 
| E.8.1.2 | Open |  No  | 
| E.8.1.3 | Single blind |  No  | 
| E.8.1.4 | Double blind  |  Yes  | 
| E.8.1.5 | Parallel group |  Yes  | 
| E.8.1.6 | Cross over  |  No  | 
| E.8.1.7 | Other |  No  | 
| E.8.2 |  Comparator of controlled trial | 
| E.8.2.1 | Other medicinal product(s) |  Yes  | 
| E.8.2.2 | Placebo  |  No  | 
| E.8.2.3 | Other |  No  | 
| E.8.3 | 
                                The trial involves single site in the Member State concerned
                             |  No  | 
| E.8.4 |  The trial involves multiple sites in the Member State concerned  |  Yes  | 
| E.8.5 | The trial involves multiple Member States |  Yes  | 
| E.8.6 Trial involving sites outside the EEA | 
| E.8.6.1 | Trial being conducted both within and outside the EEA |  Yes  | 
| E.8.6.2 | Trial being conducted completely outside of the EEA |  Information not present in EudraCT  | 
| E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned | 
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| E.8.7 | Trial has a data monitoring committee |  Information not present in EudraCT  | 
| E.8.8 | 
                        Definition of the end of the trial and justification where it is not the last
                        visit of the last subject undergoing the trial
                     |  | 
| E.8.9 Initial estimate of the duration of the trial | 
| E.8.9.1 | In the Member State concerned years | 2 | 
| E.8.9.1 | In the Member State concerned months | 4 | 
| E.8.9.1 | In the Member State concerned days |  | 
| E.8.9.2 | In all countries concerned by the trial years | 2 | 
| E.8.9.2 | In all countries concerned by the trial months | 5 |