E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Subjects with STEMI, presenting with persistent ischemic chest pain (>10 minutes) and new ≥2 mm ST-segment elevation in two adjacent ECG leads, in whom the total duration of symptoms is anticipated to be within 4 hours. |
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E.1.1.1 | Medical condition in easily understood language |
Patients with an Acute Myocardial Infarction presenting with specific abnormalities on their electrocardiogram. These patients are scheduled to undergo PCI (dotter treatment). |
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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 | 20.0 |
E.1.2 | Level | HLGT |
E.1.2 | Classification code | 10028593 |
E.1.2 | Term | Myocardial disorders |
E.1.2 | System Organ Class | 10007541 - Cardiac disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10000891 |
E.1.2 | Term | Acute myocardial infarction |
E.1.2 | System Organ Class | 10007541 - Cardiac disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10028600 |
E.1.2 | Term | Myocardial ischaemia |
E.1.2 | System Organ Class | 10007541 - Cardiac disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10081099 |
E.1.2 | Term | Acute cardiac event |
E.1.2 | System Organ Class | 10007541 - Cardiac disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 23.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10062084 |
E.1.2 | Term | Platelet aggregation |
E.1.2 | System Organ Class | 100000004848 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10050661 |
E.1.2 | Term | Platelet aggregation inhibition |
E.1.2 | System Organ Class | 10005329 - Blood and lymphatic system 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 |
Efficacy: - To assess the clinical outcome at 30 days follow-up after administration of a single subcutaneous injection of zalunfiban versus placebo in STEMI subjects in the pre-hospital setting.
Safety: - To assess bleeding events (according to Global Use of Strategies to Open Occluded Coronary Arteries [GUSTO] severe or life threatening criterion for safety assessment and, for information only, according to the Bleeding Academic Research Consortium [BARC] type 3C and 5 criteria after a single subcutaneous injection of zalunfiban versus placebo at 30 days follow-up.
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E.2.2 | Secondary objectives of the trial |
To assess after a single s.c. injection of zalunfiban vs placebo: Efficacy: -Restoration of the culprit coronary artery blood flow of the Culprit before intended PCI (or post-CAG in case no PCI performed) -Resolution of ST-segment deviation post-PCI/CAG -A composite of all cause death, recurrent MI, acute stent thrombosis, or blinded bail-out use of IV αIIbβ3 antagonists or IV P2Y12 antagonist at 30 days FU -Acute stent thrombosis at 24hr post-PCI/CAG Safety: -Safety throughout study -Platelet count pre-PCI/CAG, post-PCI/CAG, 6hr post-PCI/CAG, 24hr post-PCI/CAG and at discharge/72hr post-PCI/s - Bleeding events at 30 day FU: - According to ISTH Major - According to GUSTO mild and moderate criteria, BARC type 2, 3, and 5 criteria, ISTH minor and/or major bleeding, and TIMI minor and major criteria) -The injection site reactions of a single s.c. injection of zalunfiban/ placebo at baseline, 1hr post-PCI/CAG, hospital discharge/72hr post-PCI/CAG, and at 30 days FU |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Males aged ≥18 years or post-menopausal or surgically sterile females ≥50 years or ≥55 years (for Czech Republic study sites only). - Weight (by history) between 52 and 130 kg. - Subjects with STEMI, presenting with persistent ischemic chest pain (>10 minutes) and new ≥2 mm ST-segment elevation in two adjacent ECG leads, in whom the total duration of symptoms is 4 hours maximum. - Verbal witnessed / short written informed consent, or written informed consent signed by subject or legally authorized representative/independent witness will be obtained in the acute phase by (para)medics, according to local applicable legal regulations. Subject is willing and able to give informed consent. Written informed consent will be obtained as soon as the subject’s clinical condition allows it. |
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E.4 | Principal exclusion criteria |
- Cardiopulmonary Resuscitation (CPR) for current Out of Hospital Cardiac Arrest (OHCA). - Presenting with systolic blood pressure <90 mmHg confirmed on repeat testing and heart rate >100 beats per minute (bpm). - Current known active coronavirus disease 2019 (COVID-19) infection (criteria according to local guidelines. - Currently treated with renal dialysis. - Current treatment with oral anticoagulation (Vitamin K antagonists* [VKA] or direct oral anticoagulants** [DOACs]). * acenocoumarol or phenprocoumon ** dabigatran, apixaban, edoxaban, rivaroxaban - Major surgery, or trauma or bleeding leading to hospitalization, within the past month. - Known history of ischemic or hemorrhagic stroke. - Known severe anemia (regular blood transfusion needed). - Previously enrolled in this study. - Participation in another clinical study with an investigational product or device within the past month. - Life expectancy less than one year. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Efficacy: To assess after a single subcutaneous injection of zalunfiban versus placebo: Clinical outcome as assessed by a 7-point scale. The 7 outcomes, ranking from worst to best, are: a. Death (all cause) at 30 days follow-up b. Stroke at 30 days follow-up c. Recurrent MI (type 1 to 4 MI) at 30 days follow-up d. Acute stent thrombosis at 24 hours post-PCI/angiography e. New onset heart failure or rehospitalization for heart failure at 30 days follow-up f. MI with hs-cTnT levels ≥10x ULN at 24 hours post-PCI/angiography g. None of the above
Safety: To assess after a single subcutaneous injection of zalunfiban versus placebo: - Subject incidence of bleeding events (according to GUSTO severe or life-threatening criterion for safety assessment and, for information only, according to the BARC type 3C and 5 criteria) at 30 days follow-up |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
see primary end points (E.5.1)
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E.5.2 | Secondary end point(s) |
Efficacy: To assess after a single subcutaneous injection of zalunfiban versus placebo: - As assessed by an independent Core Laboratory: Corrected TIMI Frame Count of the Infarct-Related Artery (Culprit) before PCI/angiography - As assessed by an independent Core Laboratory: ST-segment deviation resolution 1-hour post-PCI/angiography - Time in days to a composite of all cause death or recurrent MI at 30 days follow-up or blinded bail-out use of IV αIIbβ3 antagonists or IV P2Y12 antagonists or acute stent thrombosis (according to the Academic Research Consortium [ARC] definition) at 24 hours post-PCI/angiography - Subject incidence of definite, probable, or possible acute stent thrombosis (according to the ARC definition) at 24 hours post-PCI/angiography
Safety To assess after a single subcutaneous injection of zalunfiban versus placebo: - Recording of AEs and SAEs: AEs at 30 days follow-up; SAEs up to resolution/stabilization, the SAEs mortality and hospitalization for heart failure and atrial fibrillation up to 12-months follow-up - Platelet count before PCI/angiography, at the end of the PCI/angiography, 6 and 24 hours post-PCI/angiography, and at hospital discharge/72-hours post-PCI/angiography (whichever occurs first) - Subject incidence of bleeding events (according to ISTH Major and, for information only, TIMI Major) at 30 days follow-up - Subject incidence of bleeding events according to GUSTO mild and moderate criteria, BARC type 2, 3, and 5 criteria, ISTH minor and/or major bleeding, and TIMI minor and major criteria at 30 days follow-up - Subject incidence of injection site reactions at baseline, 1-hour post-PCI/angiography, hospital discharge/72-hours post- PCI/angiography, and at 30 days follow-up |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
see secondary end points (E.5.2) |
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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 | No |
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) | 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) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 3 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 17 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 42 |
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 | No |
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 |
Canada |
United States |
France |
Netherlands |
Czechia |
Hungary |
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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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Standard care will be performed from time of consent through last study visit. The end of study for a given subject is reached when follow-up at month 12 has been completed. The end of the whole study is met when all patients have completed all assessments, all data have been cleaned and study site has been closed. Premature termination of the study: a possible reason for early study termination includes that the SRC makes a decision for the early termination of the study per recommendation.
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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 | 3 |
E.8.9.1 | In the Member State concerned months | 10 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 10 |
E.8.9.2 | In all countries concerned by the trial days | 0 |