| E.1 Medical condition or disease under investigation |
| E.1.1 | Medical condition(s) being investigated |
| myocardial damage |
| Myokardschaden |
|
| E.1.1.1 | Medical condition in easily understood language |
| damages or injury of the muscle cells of the heart |
| Herzmuskelschaden |
|
| E.1.1.2 | Therapeutic area | Diseases [C] - Cardiovascular Diseases [C14] |
| MedDRA Classification |
| 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 |
| To determine the efficacy of goal-directed heart rate control to attenuate cardiac troponin plasma level elevation after non-cardiac surgery using the ultra-short acting β-blocker esmolol during emergence from anesthesia and during post-anesthesia care. |
|
| E.2.2 | Secondary objectives of the trial |
| To determine the feasibility of goal-directed heart rate control using the ultra-short acting β-blocker esmolol. |
|
| E.2.3 | Trial contains a sub-study | No |
| E.3 | Principal inclusion criteria |
• ≥ 45 years
• scheduled for elective major non-cardiac surgery
• general anesthesia (using general anesthetic drug(s) and opioids)
• anticipated postoperative hospital stay for > 2 days
• no treatment with β-receptor blocking drugs for more than 30 days
• increased cardiovascular risk because of history of coronary artery disease or a combination of ≥ 2 of the following risk factors: ≥ 70 years, congestive heart failure (NYHA ≤ II), chronic renal failure, smoking history, hypertension, diabetes, lipid-lowering drug treatment or hypercholesterolemia, and obesity (BMI > 35).
|
|
| E.4 | Principal exclusion criteria |
• patients who do not understand the informed consent
• spinal or epidural anesthesia
• history of ischemic cerebrovascular disease
• severe asthma and COPD
• preoperative heart rate <61 beats per minute (bpm)
• cardiac pacemaker
• atrioventricular block type 2 and 3
• sick sinus syndrome
• sinoatrial block
• cardiogenic shock
• congestive heart failure (NYHA III or IV)
• pulmonary hypertension
• untreated pheochromocytoma
• pulmonary edema
• persons with increased vulnerability (e.g. cognitive limitations)
• pregnant, or breast-feeding
• current administration of cardiodepressant calcium channel antagonists, cardiac glycosides (digoxin, digitoxin) ), or If-inhibitors (such as ivabradin)
• end-stage liver disease
• intolerances or hypersensitivity reactions to study drug
• previous participation in the study
• participation in another, possibly interfering trial
|
|
| E.5 End points |
| E.5.1 | Primary end point(s) |
| Myocardial injury measured as the peak postoperative hs-cTnT. |
|
| E.5.1.1 | Timepoint(s) of evaluation of this end point |
| After surgery until postoperative day 3 |
|
| E.5.2 | Secondary end point(s) |
|
| E.5.2.1 | Timepoint(s) of evaluation of this end point |
| During anesthesia and at PACU |
|
| E.6 and E.7 Scope of the trial |
| E.6 | Scope of the trial |
| E.6.1 | Diagnosis | No |
| E.6.2 | Prophylaxis | Yes |
| E.6.3 | Therapy | Yes |
| E.6.4 | Safety | No |
| E.6.5 | Efficacy | Yes |
| E.6.6 | Pharmacokinetic | Yes |
| E.6.7 | Pharmacodynamic | Yes |
| E.6.8 | Bioequivalence | No |
| E.6.9 | Dose response | Yes |
| 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) | No |
| 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 | No |
| 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 | Yes |
| E.8.1.7.1 | Other trial design description |
|
| E.8.2 | Comparator of controlled trial |
| E.8.2.1 | Other medicinal product(s) | Yes |
| E.8.2.2 | Placebo | Yes |
| 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.8.5 | 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
|
|
| E.8.9 Initial estimate of the duration of the trial |
| E.8.9.1 | In the Member State concerned years | 1 |
| E.8.9.1 | In the Member State concerned months | 0 |
| E.8.9.1 | In the Member State concerned days | 0 |