ST-elevation Myocardial Infarction Clinical Trial
— MULTISTARS AMIOfficial title:
MULTivessel Immediate Versus STAged RevaScularization in Acute Myocardial Infarction - The MULTISTARS AMI Trial
NCT number | NCT03135275 |
Other study ID # | MULTISTARS_USZ |
Secondary ID | |
Status | Completed |
Phase | N/A |
First received | |
Last updated | |
Start date | October 2016 |
Est. completion date | May 2023 |
Verified date | January 2024 |
Source | University of Zurich |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
The primary objective of the trial is to compare, in patients presenting with ST segment elevation myocardial infarction (STEMI) and multi-vessel disease (MVD), the safety and efficacy of immediate complete revascularization of all significant coronary lesions versus culprit vessel only revascularization and staged percutaneous coronary intervention (PCI) of all significant coronary lesions (within 19 to 45 days), in a non-inferiority trial using a third generation, biodegradable-polymer, everolimus-eluting stent.
Status | Completed |
Enrollment | 840 |
Est. completion date | May 2023 |
Est. primary completion date | May 2023 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Age = 18 years - Spontaneous acute STEMI (patients presenting within 24 hours of symptom onset) - Suitability for PCI from femoral or radial access - Coronary anatomy suitable for complete coronary revascularization with Synergy® stent implantation - Identifiable culprit lesion/artery - At least one non-culprit coronary stenosis = 70% in at least two projections, in a vessel with a lumen diameter =2.25 - =5.75 mm, other than the culprit artery - TIMI Flow 3 or TIMI flow 2 after revascularization of the culprit artery - Stable hemodynamics at the end of the culprit vessel revascularization Exclusion Criteria: - Inability to give informed consent - Cardiogenic shock - Prolonged resuscitation >10 min - General unsuitability for PCI - Need for emergency CABG - Previous CABG - Planned hybrid revascularization - Coronary artery dissection - STEMI due to ST - Previous documented allergic reaction to everolimus or to any stent material - Severe mechanical complication of acute myocardial infarction - Pre-existing severe renal failure (eGFR <30 mL/min) or renal replacement therapy - Chronic total occlusion of a major coronary artery - Left main stem stenosis =50% or left main stem equivalent (ostial left anterior descending and ostial circumflex stenosis =70%) - In-stent restenosis - Panned coronary, cerebrovascular, or peripheral arterial revascularization - Planned cardiac or major surgery - Any contraindications for dual antiplatelet therapy with aspirin and a P2Y12 Inhibitor for at least 90 days, except for patients on oral anticoagulation - Known pregnancy at the time of inclusion - Participation in another clinical study with an investigational product - Life expectancy <1 year |
Country | Name | City | State |
---|---|---|---|
Switzerland | University Hospital Zürich, Cardiology Department | Zurich |
Lead Sponsor | Collaborator |
---|---|
University of Zurich |
Switzerland,
Authors/Task Force members; Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Juni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014 Oct 1;35(37):2541-619. doi: 10.1093/eurheartj/ehu278. Epub 2014 Aug 29. No abstract available. — View Citation
Cavender MA, Milford-Beland S, Roe MT, Peterson ED, Weintraub WS, Rao SV. Prevalence, predictors, and in-hospital outcomes of non-infarct artery intervention during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (from the National Cardiovascular Data Registry). Am J Cardiol. 2009 Aug 15;104(4):507-13. doi: 10.1016/j.amjcard.2009.04.016. Epub 2009 Jun 18. — View Citation
Engstrom T, Kelbaek H, Helqvist S, Hofsten DE, Klovgaard L, Holmvang L, Jorgensen E, Pedersen F, Saunamaki K, Clemmensen P, De Backer O, Ravkilde J, Tilsted HH, Villadsen AB, Aaroe J, Jensen SE, Raungaard B, Kober L; DANAMI-3-PRIMULTI Investigators. Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3-PRIMULTI): an open-label, randomised controlled trial. Lancet. 2015 Aug 15;386(9994):665-71. doi: 10.1016/s0140-6736(15)60648-1. — View Citation
Gershlick AH, Khan JN, Kelly DJ, Greenwood JP, Sasikaran T, Curzen N, Blackman DJ, Dalby M, Fairbrother KL, Banya W, Wang D, Flather M, Hetherington SL, Kelion AD, Talwar S, Gunning M, Hall R, Swanton H, McCann GP. Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: the CvLPRIT trial. J Am Coll Cardiol. 2015 Mar 17;65(10):963-72. doi: 10.1016/j.jacc.2014.12.038. — View Citation
Kornowski R, Mehran R, Dangas G, Nikolsky E, Assali A, Claessen BE, Gersh BJ, Wong SC, Witzenbichler B, Guagliumi G, Dudek D, Fahy M, Lansky AJ, Stone GW; HORIZONS-AMI Trial Investigators. Prognostic impact of staged versus "one-time" multivessel percutaneous intervention in acute myocardial infarction: analysis from the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial. J Am Coll Cardiol. 2011 Aug 9;58(7):704-11. doi: 10.1016/j.jacc.2011.02.071. — View Citation
Sabate M, Raber L, Heg D, Brugaletta S, Kelbaek H, Cequier A, Ostojic M, Iniguez A, Tuller D, Serra A, Baumbach A, von Birgelen C, Hernandez-Antolin R, Roffi M, Mainar V, Valgimigli M, Serruys PW, Juni P, Windecker S. Comparison of newer-generation drug-eluting with bare-metal stents in patients with acute ST-segment elevation myocardial infarction: a pooled analysis of the EXAMINATION (clinical Evaluation of the Xience-V stent in Acute Myocardial INfArcTION) and COMFORTABLE-AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction) trials. JACC Cardiovasc Interv. 2014 Jan;7(1):55-63. doi: 10.1016/j.jcin.2013.07.012. Epub 2013 Dec 11. — View Citation
Stahli BE, Varbella F, Linke A, Schwarz B, Felix SB, Seiffert M, Kesterke R, Nordbeck P, Witzenbichler B, Lang IM, Kessler M, Valina C, Dibra A, Rohla M, Moccetti M, Vercellino M, Gaede L, Bott-Flugel L, Jakob P, Stehli J, Candreva A, Templin C, Schindler — View Citation
Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC); Steg PG, James SK, Atar D, Badano LP, Blomstrom-Lundqvist C, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, Lenzen MJ, Mahaffey KW, Valgimigli M, van 't Hof A, Widimsky P, Zahger D. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012 Oct;33(20):2569-619. doi: 10.1093/eurheartj/ehs215. Epub 2012 Aug 24. No abstract available. — View Citation
Wald DS, Morris JK, Wald NJ, Chase AJ, Edwards RJ, Hughes LO, Berry C, Oldroyd KG; PRAMI Investigators. Randomized trial of preventive angioplasty in myocardial infarction. N Engl J Med. 2013 Sep 19;369(12):1115-23. doi: 10.1056/NEJMoa1305520. Epub 2013 Sep 1. — View Citation
Widimsky P, Holmes DR Jr. How to treat patients with ST-elevation acute myocardial infarction and multi-vessel disease? Eur Heart J. 2011 Feb;32(4):396-403. doi: 10.1093/eurheartj/ehq410. Epub 2010 Nov 30. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Cost-effectiveness analysis | 1 year | ||
Primary | The primary outcome measure is a composite of all-cause death, non-fatal myocardial infarction, unplanned ischemia-driven revascularization, hospitalization for heart failure, and stroke at 1 year | 1-year | ||
Secondary | All-cause death, non-fatal myocardial infarction, unplanned ischemia-driven revascularization, hospitalization for heart failure, and stroke | Primary endpoint | 6 months | |
Secondary | All-cause death | Single components of the primary endpoint | 6 months, 1 year | |
Secondary | Non-fatal myocardial infarction | Single components of the primary endpoint | 6 months, 1 year | |
Secondary | Unplanned ischemia-driven revascularization | Single components of the primary endpoint | 6 months, 1 year | |
Secondary | Hospitalization for heart failure | Single components of the primary endpoint | 6 months, 1 year | |
Secondary | Stroke | Single components of the primary endpoint | 6 months, 1 year | |
Secondary | Target lesion revascularization (TLR) | 6 months, 1 year | ||
Secondary | Target vessel revascularization (TVR) | 6 months, 1 year | ||
Secondary | Non-cardiovascular death | 6 months, 1 year | ||
Secondary | Cardiac death | 6 months, 1 year | ||
Secondary | Cardiovascular death | 6 months, 1 year | ||
Secondary | Cardiac death or myocardial infarction | 6 months, 1 year | ||
Secondary | All-cause death or myocardial infarction | 6 months, 1 year | ||
Secondary | Stent thrombosis | 6 months, 1 year | ||
Secondary | Acute renal insufficiency or dialysis | 6 months, 1 year | ||
Secondary | Procedural success | 6 months, 1 year | ||
Secondary | Bleeding event (BARC definition) | 6 months, 1 year | ||
Secondary | Quality of life (EQ-5D questionnaire) | 6 months, 1 year |
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