E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
ACUTE MYOCARDIAL INFARCTION |
INFARTO AGUDO DE MIOCARDIO |
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E.1.1.1 | Medical condition in easily understood language |
ACUTE MYOCARDIAL INFARCTION |
INFARTO AGUDO DE MIOCARDIO |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cardiovascular Diseases [C14] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10000894 |
E.1.2 | Term | Acute myocardial infarction, of anterolateral wall, initial episode of care |
E.1.2 | System Organ Class | 10007541 - Cardiac disorders |
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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 |
Primary angioplasty (primary PCI) is the preferred procedure to treat patients with ST- elevation acute myocardial infarction (STEMI). We sought to investigate whether, in patients with STEMI of anterior wall who are treated with standard pharmacological treatment (aspirin, a thienopiridine and heparin) and primary angioplasty, an intracoronary administration (instead of intravenous administration) of a fibrinolytic agent (tenecteplase) could be superior to that of the antiplatelet abciximab (a GP IIbIIIa platelet inhibitor) in the reduction of the final size of the myocardial infarction, on the basis of a higher efficacy of the fibrinolytic agent in the resolution of the macrovascular and microvascular obstruction by coronary thrombi |
La angioplastia primaria (ICP primaria) es el procedimiento de elección para tratar a los pacientes con infarto agudo de miocardio con elevación del ST (IAMEST). Nos proponemos investigar si, en pacientes con IAMEST de localización anterior tratados con la terapia farmacológica habitual (aspirina, una tienopiridina y heparina) que son sometidos a ICP primaria, la administración directa por vía intracoronaria (i.c.) de un fibrinolítico (tenecteplasa i.c.) (TNK i.c.) pueda ser superior a la terapia habitual con un antiagregante plaquetario inhibidor de la GP IIbIIIa (abciximab i.c.) en la reducción del tamaño final del infarto, a través de una mayor eficacia en la disminución de la obstrucción macro y microvascular por trombos intracoronarios. En definitiva, el objetivo primario del estudio es comprobar si hay diferencias entre ambos grupos de tratamiento en el tamaño final del infarto (valorado mediante angio-RMN a los 4 meses del IAMEST). |
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E.2.2 | Secondary objectives of the trial |
-To assess which one of both antithrombotic treatments (tenecteplase vs abciximab) is more adequate to disolve coronary thrombus when administered during primary angioplasty in STEMI patients, and to improve myocardial perfusion -To analyze whether intracoronary tenecteplase reduces the final myocardial infarction more than the antiplatelet abciximab does (as assessed with both a cardiac magnetic resonance and the ROC curve of the release of myocardial damage biochemical markers) -To evaluate the effect of both drugs on the preservation of systolic and diastolic ventricular function -To evaluate which variables (including the study drugs) are predictive of ventricular remodeling - To identify which variables are predictive of adverse outcome in these patients -To evaluate the safety of the intracoronary administration of tenecteplase, compared with the safety of intracoronary abciximab |
-Averiguar el tipo de fármaco más apropiado (tenecteplasa vs abciximab) para disolver localmente el trombo coronario durante la angioplastia primaria del IAMEST, y mejorar la perfusión miocárdica. -Analizar si la fibrinolisis intracoronaria (TNK) reduce más el tamaño del infarto (mediante angio-RMN y mediante curva ROC de liberación de marcadores de daño miocárdico) que la habitual administración intracoronaria de un antiagregante potente (abciximab). -Evaluar el efecto de ambos fármacos sobre la preservación de la función ventricular (tanto sistólica como diastólica). -Indagar si el tipo de fármaco administrado, u otras variables (clínicas, ecocardiográficas angiográficas…), son predictoras de un remodelado ventricular adverso. -Identificar las variables predictoras de la evolución clínica de estos pacientes. -Comprobar la seguridad de la administración local (intracoronaria) de la tenecteplasa, y compararla con la del abciximab intracoronario. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
-ST-segment elevation acute myocardial infarction (STEMI) < 12 hours, with ST elevation ≥ 2mm in precordial leads in ECG (compatible with STEMI of anterior wall), or new-onset left-bundle branch block -Performance of urgent coronary angiography with evidence of a coronary flow limitant lesion in left-descending coronary artery (TIMI 0-2 flow) and intention to perform primary angioplasty -Written informed consent for study |
-Cuadro de IAMEST con evolución < 12 horas, junto a elevación del ST ≥ 2 mm en al menos 3 derivaciones precordiales contiguas compatible con IAMEST de localización anterior, o BCRIHH de nueva aparición. -Realización de coronariografía urgente con hallazgo de lesión responsable limitante al flujo en arteria coronaria descendente anterior (flujo TIMI 0-2), e intención de realizar angioplastia primaria. -Haber firmado el consentimiento informado al estudio |
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E.4 | Principal exclusion criteria |
-Cardiogenic shock -Previous myocardial infarction (chronic) -Sever active bleeding -Contraindications for fibrinolytics or abciximab -Contraindicaction for cardiac magnetic resonance with contrast (angio-MNR), such as metallic intracraneal implants, pacemakers, moderate-to-severe renal insufficiency) -Age under 18 -Pregnancy -Severe hepatic insufficiency -Severe diseases which can limit life expectancy under 12 months |
-Shock cardiogénico. -Infarto de miocardio previo. -Sangrado activo severo. -Contraindicación para fibrinolíticos o para abciximab. -Contraindicación para angio-RMN (implantes metálicos intracraneales, marcapasos, insuf renal moderada-severa). -Edad inferior a 18 años. -Embarazo. -Insuficiencia hepática severa. -Enfermedades severas con expectativa de vida < 12 meses. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Comparison between both treatment groups (intracoronary teneceplase group vs abciximab group) in final myocardial infarction size (as assessed with cardiac magnetic resonance with agent contrast -gadobutrol- performed 4 months after STEMI -Definition of final myocardial infarct size: mass of left ventricle which shows late enhancement with gadobutrol in the angio-MNR performed 4 months after STEMI (mass is expressed as grames and as percent of the whole mass of left ventricle), as assessed by an expertise radiologist who is unaware ot the study drug received by the patient during primary angioplasty |
Comparación entre ambos grupos de tratamiento en el tamaño final del infarto (valorados mediante angio-RMN con gadobutrol a los 4 meses del IAMEST). -Definición de tamaño final del infarto: Masa del VI que muestra realce tardío de gadobutrol en la angio-RMN realizada a los 4 meses del IAMEST (expresada tanto en gr como en porcentaje respecto a la masa total del VI), evaluado por un radiólogo experto que desconoce el fármaco asignado durante la angioplastia primaria. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Cardiac magnetic resonance (with contrast agent) at four months after index event (STEMI) |
Angio-RMN: a los 4 meses del evento índice (IAMEST) |
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E.5.2 | Secondary end point(s) |
----Efficacy variables related to myocardial perfusion and ventricular function: -Electrocardiographic: Percent of ST segment elevation resolution in ECG performed 90 minutes after primary angioplasty (with respect to basal ECG, as expressed in mV and percent value) -Biochemical myocardial infarct size: Area under ROC curve of the release of CK and troponin -Angiographic: Corrected TIMI frame count, myocardial perfusion grade (myocardial blush grade, TMPG 0-3), left ventricle ejection fraction (%) -Echocardiographic (Doppler): deceleration time of mitral inflow, R/A ratio, E/E’ ratio, Tei index, end-systolic and end-diastolic left ventricle volumes, ejection fraction ---Safety variables: major cardiovascular events, and major bleeding events. -Definition of major cardiovascular events: death, new-onset myocardial infarction (chest pain plus new ST segment changes plus new CK-MB elevation), stroke or target-lesion revascularization during follow-up. -Definition of major bleeding events: those which result in death, a drop > 4 gr/dl in hemoglobin, intrapericardial effusion which results in cardiac tamponade, or any intracraneal bleeding |
----Variables de eficacia relacionadas con la perfusión miocárdica y la función ventricular: -Electrocardiográficas: Porcentaje de resolución del ascenso del segmento ST a los 90 minutos de la angioplastia. -Tamaño enzimático del infarto: Area bajo la curva ROC de la liberación de CPK y troponina I. -Angiográficas: Flujo epicárdico (TIMI frame count corregido), perfusión miocárdica (grado de tatuaje miocárdico TMPG), y fracción de eyección (FE) del ventrículo izquierdo (VI). -Ecocardiográficas: tiempo desaceleración del llenado ventricular izquierdo, relación E/A de dicho llenado, cociente E/E’, índice Tei, volúmenes telediastólico y telesistólico del ventrículo izquierdo, fracción de eyección. ---Variables de seguridad: eventos cardiovasculares mayores, y hemorragias mayores. -Definición de eventos cardiovasculares mayores: muerte, reinfarto de miocardio (nuevo episodio de dolor torácico más nuevos cambios del segmento ST más nueva curva de elevación de CPK-MB), ictus, o necesidad de nueva revascularización de la lesión tratada durante la angioplastia primaria en el seguimiento. -Definición de hemorragias mayores: aquellas que provocan muerte, necesidad de transfusión, caída de la hemoglobina en más de 4 gr/dl, hemorragia intrapericárdica que provocase taponamiento cardiaco, o cualquier hemorragia intracraneal. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
----Efficacy variables related to myocardial perfusion and ventricular function: -Electrocardiographic: At admission and 90 minutes after primary angioplasty -Biochemical myocardial infarct size: 72 hours after STEMI onset -Angiographic: Just after primary angioplasty, and 12-24 hours later (angiographic control 12-24 hours later) -Echocardiographic (Doppler): Basal and 6 months after STEMI ---Safety variables: major cardiovascular events, and major bleeding events: At 12-month follow-up |
----Variables de eficacia relacionadas con la perfusión miocárdica y la función ventricular: -Electrocardiográficas: Al ingreso y a los 90 minutos de la angioplastia. -Tamaño enzimático del infarto: en las 72 horas siguientes al IAMEST. -Angiográficas: Justo tras la angioplastia, y a las 12-24 horas de la misma en nuevo control angiográfico. -Ecocardiográficas: En la primera semana del IAMEST (durante el ingreso) y a los 6 meses ---Variables de seguridad: eventos cardiovasculares mayores, y hemorragias mayores: en los primeros 12 meses de seguimiento |
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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 | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
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) | Yes |
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 | Yes |
E.8.1.4 | Double blind | No |
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.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.4.1 | Number of sites anticipated in Member State concerned | 1 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | Yes |
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
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AFTER RECRUITMENT OF 60 PATIENTS AND HAVING 12-MONTH FOLLOW-UP OF THEM |
TRAS INCLUIR 60 PACIENTES Y HABER COMPLETADO EL SEGUIMIENTO DE ELLOS AL AÑO DE SU INCLUSION |
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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 | 6 |
E.8.9.1 | In the Member State concerned days | 0 |