Clinical Trials Logo

Clinical Trial Summary

• The aim of the VIP study is to investigate the impact of vulnerability markers (inflammatory serum biomarkers for systemic vulnerability, coronary shear stress and vulnerability mapping for pancoronary vulnerability, and imaging-based plaque features for systemic vulnerability) on the rate of major adverse cardiovascular events caused by progression of the non-culprit lesion in patients with acute ST or non-ST segment elevation myocardial infarction who undergo revascularization of the culprit lesion during the acute event. Furthermore, the study will evaluate the rate of progression of non-culprit lesions towards a higher degree of vulnerability, based on coronary computed tomography angiographic assessment at 1 year after enrollment.

Clinical Trial Description

The project is a prospective, cohort, mono-centric study which will be carried out in the Center of Advanced Research in Multimodal Cardiac Imaging Cardiomed.

The project will include 100 subjects who present ST and non-ST segment elevation myocardial infarction at 30 days prior to study enrollment, who underwent emergency revascularization of the culprit lesion. Samples for systemic serum biomarkers for myocardial injury, myocardial strain and enhanced systemic inflammation will be collected at the moment of the acute event. All patients will undergo coronary CT angiography, cardiac perfusion CT and intracoronary imaging procedures (Intravascular ultrasound - IVUS; Optical Coherence Tomography - OCT) at the moment of enrollment in the study, for complex assessment of non-culprit coronary lesions. The endothelial coronary shear stress will be calculated with imaging post-processing techniques on the CT data acquired at baseline, by using computational fluid dynamics.

The study will be conducted over a period of 3 years, in which patients will be examined at baseline, and during several follow-up visits. At the one-year follow-up, the study subjects will undergo CT coronary angiography for re-evaluation of the non-culprit lesions, in the prospects of analyzing the rate of plaque progression towards a higher degree of vulnerability. At the end of the 3-year period, patients will be assessed about the occurrence of major adverse cardiovascular events and the rate or revascularization for non-culprit lesions.

Study objectives:

Primary: to investigate the association between systemic, pancoronary and local vulnerability features of coronary plaques and the risk for major adverse cardiac events - MACE (all-cause mortality, cardiovascular death, myocardial infarction, repeated revascularization, repeated hospitalizations for cardiovascular related incidents, cerebrovascular events) during a 3-year follow-up.

Secondary: to assess the rate of progression for the non-culprit lesions towards a higher degree of vulnerability, as evaluated via coronary CT angiography at 1 year after enrollment, in relation to systemic, pancoronary and local vulnerability features at baseline.

To identify the type of vulnerability (systemic, pancoronary or local) with the highest impact on plaque progression and future MACE

Study Timeline:

Baseline (day 0)

- Obtain and document consent from participant on study consent form.

- Verify inclusion/exclusion criteria.

- Obtain demographic information, medical history, medication history, alcohol and tobacco use history.

- Record results of physical examinations and 12-lead ECG.

- Collect blood specimens.

- Imaging procedures: transthoracic 2-D echocardiography, 128-multisclice CT angiography, cardiac perfusion CT, IVUS, OCT

Visit 1 (month 1)

- Record results of physical examinations, 12-lead ECG and medical history.

- Imaging procedures: transthoracic 2-D echocardiography

Visit 2 (month 3)

• Telephone follow-up

Visit 3 (month 6)

- Record results of physical examinations, 12-lead ECG and medical history.

- Imaging procedures: transthoracic 2-D echocardiography

Visit 4 (month 12)

- Record results of physical examinations, 12-lead ECG and medical history.

- Imaging procedures: transthoracic 2-D echocardiography, 128-multislice CT coronary angiography for evaluation of non-culprit lesion

- End-point evaluation

Visit 5 (month 15)

• Telephone follow-up

Visit 6 (month 18)

• Telephone follow-up

Visit 7 (month 24)

- Record results of physical examinations, 12-lead ECG and medical history.

- Imaging procedures: transthoracic 2-D echocardiography.

- End-point evaluation

Visit 8 (month 30)

• Telephone follow-up

Final study visit (month 36)

- Record results of physical examinations, 12-lead ECG and medical history.

- Imaging procedures: transthoracic 2-D echocardiography

- End-point evaluation.

Study procedures:

- Clinical examination, medical history

- 12-lead ECG

- 2D transthoracic echocardiography with measurement of: cardiac diameters, volumes, valvular function and regurgitation, pressure gradients, pericardial fat thickness, pericardial effusion, left ventricular global and regional function and ejection fraction.

- 128-multislice CT coronary angiography with the evaluation of: epicardial fat volume, plaque burden, total and local calcium score, markers for lesion severity (degree of stenosis, lesion length, lumen area and diameter, minimum and maximum plaque thickness); morphological plaque characteristics (plaque related volumes, plaque burden, vascular indexes - remodeling and eccentricity index); plaque components evaluated via volumetric and planimetric units (necrotic core, fibrofatty tissue, fibrotic tissue, dense calcium); markers of plaque vulnerability (necrotic core, low attenuation plaque, spotty calcification, napkin ring sign, positive remodeling).

- Shear stress evaluation of CT acquired images and computational fluid dynamics

- Intracoronary imaging techniques: IVUS and OCT with evaluation of plaque characteristics.

- Venous blood sample collection during the acute coronary event for evaluation of serum levels of hsCRP, IL-6, matrixmetalloproteases MMP9, Adhesion molecules (VCAM, ICAM), alfa tumour necrosis factor, hs-cTnI, NTproBNP

Data collection: In a dedicated database that includes all patient information, demographics, medical history, medication, therapeutic procedures, information derived from imaging techniques (echocardiography, CT angiography, CT imaging post-processing and shear stress evaluation). ;

Study Design

Related Conditions & MeSH terms

NCT number NCT03606330
Study type Observational
Source Cardio Med Medical Center
Contact Theodora Benedek, Professor
Phone +40 265 217 333
Status Recruiting
Start date October 22, 2018
Completion date November 1, 2022

See also
  Status Clinical Trial Phase
Completed NCT02750579 - Early or Delayed Revascularization for Intermediate and High-risk Non ST-elevation Acute Coronary Syndromes? N/A
Enrolling by invitation NCT03342131 - Serum Concentration of Wnt2 and Wnt4 in Patients With Acute Coronary Syndrome N/A
Recruiting NCT03218007 - A2 AR as a Novel Biomarkers for Physician Decision-making Improvement Evaluation's Patients With Suspected Acute Coronary Syndrome But Negative Troponin. N/A
Recruiting NCT02925923 - Crushed Ticagrelor Versus Eptifibatide Bolus + Clopidogrel Phase 2
Recruiting NCT02944123 - Half Dose of Prasugrel and Ticagrelor in Acute Coronary Syndrome (HOPE-TAILOR) Phase 3
Recruiting NCT02892903 - In the Management of Coronary Artery Disease, Does Routine Pressure Wire Assessment at the Time of Coronary Angiography Affect Management Strategy, Hospital Costs and Outcomes? N/A
Not yet recruiting NCT02871622 - BMX Alpha Registry: a Post-market Registry of the BioMatrix Alpha TM N/A
Recruiting NCT02533128 - Biomarkers, Blood Pressure, BIS: Risk Stratification/Management of Patients at Cardiac Risk in Major Noncardiac Surgery N/A
Recruiting NCT02620202 - Aiming Towards Evidence Based Interpretation of Cardiac Biomarkers in Patients Presenting With Chest Pain
Recruiting NCT02673437 - Rivaroxaban ACS Specialist Cohort Event Monitoring Study N/A
Active, not recruiting NCT02922140 - The Impact of Pharmaceutical Care Practice on Patients in Cardiac Rehabilitation Unit N/A
Active, not recruiting NCT02887066 - Observatory on Emergency Care for Acute Coronary Syndrome in Grand Est of France N/A
Active, not recruiting NCT02374775 - Exploring the MEchanism of Plaque Rupture in Acute Coronary Syndrome Using Coronary CT Angiography and computationaL Fluid Dynamic N/A
Completed NCT02044146 - A Pharmacodynamic Study of a Personalized Strategy for P2Y12 Inhibition Versus Ticagrelor in Reducing Ischemic and Bleeding Risk Phase 2/Phase 3
Recruiting NCT01931852 - Cardiac Magnetic Resonance Imaging Strategy for the Management of Patients With Acute Chest Pain and Detectable to Elevated Troponin N/A
Completed NCT01826994 - Incremental Value of Point of Care H-FABP Testing in Primary Care Patients Suspected of Acute Coronary Syndrome N/A
Completed NCT01959451 - Testing Responsiveness to Platelet Inhibition on Chronic Antiplatelet Treatment For Acute Coronary Syndromes Trial Phase 4
Recruiting NCT01681381 - Evaluate Safety And Effectiveness Of The Tivoli® DES and The Firebird2® DES For Treatment Coronary Revascularization N/A
Completed NCT01642966 - Differential Effect of Ticagrelor Versus Prasugrel on the Adenosine-induced Coronary Vasodilatory Responses in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention Phase 4
Completed NCT01609647 - Reloading Prasugrel or Clopidogrel on High Platelet Reactivity Before Percutaneous Coronary Intervention Phase 3