Unstable Angina Clinical Trial
— APACHEOfficial title:
Appropriateness of Coronary Angioplasty in PAtients With isCHEmic Heart Disease
An observational, retrospective, multicenter, blinded adjudication study to evaluate the
clinical appropriateness of Percutaneous Coronary Intervention (PCI) indication and
execution in patients with stable Coronary Artery Disease (CAD) and in patients with acute
coronary syndrome without ST-segment elevation (NSTE-ACS) (ratio 4:1). Half of the included
patients will be diabetic. Also the implementation of selected, key guideline
recommendations will be examined.
At least 400 patients will be retrospectively selected among 22 Catheterization Laboratories
in Italy in the region of Lombardia and Veneto.
This study will be conducted in compliance with Good Clinical Practices (GCP) including the
Declaration of Helsinki and all applicable regulatory requirements.
Status | Recruiting |
Enrollment | 400 |
Est. completion date | July 2016 |
Est. primary completion date | May 2016 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | N/A and older |
Eligibility |
Inclusion criteria: - Age >= 18 yrs - Stable Coronary Artery Disease(CAD) - Unstable Angina or NSTEMI Exclusion criteria : - STEMI at presentation - previous CABG |
Observational Model: Cohort, Time Perspective: Retrospective
Country | Name | City | State |
---|---|---|---|
Italy | IRCCS Policlinico S. Matteo | Pavia | Pv |
Lead Sponsor | Collaborator |
---|---|
Italian Society of Invasive Cardiology | IRCCS Policlinico S. Matteo |
Italy,
Bauer T, Möllmann H, Weidinger F, Zeymer U, Seabra-Gomes R, Eberli F, Serruys P, Vahanian A, Silber S, Wijns W, Hochadel M, Nef HM, Hamm CW, Marco J, Gitt AK. Predictors of hospital mortality in the elderly undergoing percutaneous coronary intervention fo — View Citation
Coronary Revascularization Writing Group, Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA; Technical Panel, Masoudi FA, Dehmer GJ, Patel MR, Smith PK, Chambers CE, Ferguson TB Jr, Garcia MJ, Grover FL, Holmes DR Jr, Klein LW, Limacher MC, Mack MJ, — View Citation
Dauerman HL. Reasonable incomplete revascularization. Circulation. 2011 May 31;123(21):2337-40. doi: 10.1161/CIRCULATIONAHA.111.033126. Epub 2011 May 16. — View Citation
Généreux P, Palmerini T, Caixeta A, Rosner G, Green P, Dressler O, Xu K, Parise H, Mehran R, Serruys PW, Stone GW. Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention: the residual SYNTAX (Synergy Betwee — View Citation
Lucas FL, Siewers AE, Malenka DJ, Wennberg DE. Diagnostic-therapeutic cascade revisited: coronary angiography, coronary artery bypass graft surgery, and percutaneous coronary intervention in the modern era. Circulation. 2008 Dec 16;118(25):2797-802. doi: — View Citation
Miller FG, Emanuel EJ. Quality-improvement research and informed consent. N Engl J Med. 2008 Feb 21;358(8):765-7. doi: 10.1056/NEJMp0800136. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Proportion of patients with stable Coronary Artery Disease (CAD) whose clinical indication was appropriate for the treatment with Percutaneous Coronary Intervention (PCI). | Appropriateness will be defined by a final score of = 7 of the Central Heart Team according to appropriate use criteria. | 3 months | No |
Secondary | Proportion of patients with complex lesions (left main, proximal LAD, three-vessel disease) treated ad hoc without documentation of Heart Team discussion in the medical records with stable CAD. | 3 months | No | |
Secondary | Proportion of patients receiving incomplete revascularization (i.e. residual SYNTAX > 8)Heart Team or in patients without documented ischemia with stable CAD. | 3 months | No | |
Secondary | Proportion of patients receiving guideline-recommended medical therapy at the time of PCI with stable CAD. | 3 months | No | |
Secondary | Incidence of FFR-guided PCI for stenosis of uncertain significance according to the Central Heart Team or in patients without documented ischemia with stable CAD. | 3 months | No | |
Secondary | Proportion of patients who received PCI but with an indication for CABG according to guidelines and no Heart team discussion in the medical record with stable CAD. | 3 months | No | |
Secondary | Proportion of patients treated with PCI whose clinical indication appears appropriate defined by a final score of = 7 of the Heart Team according to appropriate use criteria for Non ST elevation ACS (nSTE-ACS). | 3 months | No | |
Secondary | Proportion of PCI procedures performed within 24 hours of admission in patients with nSTEACS with GRACE> 140 for nSTE-ACS. | 3 months | No | |
Secondary | Proportion of patients with nSTEACS who are stabilized (no recurrent ischemic symptoms) who have multivessel disease and a high SYNTAX score (>22), without documentation of Heart Team discussion in the medical records for nSTE-ACS. | 3 months | No |
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