Correlation Between Coronary and Carotid Atherosclerotic Disease and Links With Clinical Outcomes

Vascular Disease Clinical Trial

Official title:

Global Observational Study to Evaluate the Correlation Between Coronary and Carotid Atherosclerotic Disease (CAD) and Links With Clinical Outcomes

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02114541
• Other study ID #: CAIN-003_MHICC-31052012
• Status: Completed
• Start date: February 3, 2010
• Est. completion date: December 12, 2017

Study information

• Verified date: February 2022
• Source: Montreal Heart Institute
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The relationship of the natural history of atherosclerosis between different vascular beds has not been well characterized. Determination and comparison of the relative rates of progression and extents of atherosclerosis in the coronary and carotid arterial trees may have major impacts on clinical research and clinical practice. Correlation between findings in the carotid and coronary circulations is an important scientific and clinical topic to address. Results from a well design study incorporating imaging technologies that currently represent the gold standards for the assessment of coronary and carotid artery plaque burden, will have potentially impact on clinical research and clinical practice.

Description:

The CAIN-003 study was a prospective observational multi-center imaging study of subjects scheduled for clinically-indicated coronary angiography. CAIN-003 provided for the collection of baseline coronary angiography and IVUS imaging data along with baseline carotid ultrasound imaging. CAIN-003 study participants underwent follow-up coronary and carotid imaging at 2-years, and were then contacted by phone on an annual basis for an additional 3 years for the collection of cardiovascular and cerebrovascular clinical endpoints. MHICC-31052012 was a prospective, observational, multi-center study of subjects who had successfully undergone baseline imaging in the dal-PLAQUE 2 study (A multicenter, double-blind, randomized, placebo-controlled study, evaluating the effect of treatment with dalcetrapib 600 mg on atherosclerosis disease). The dal-PLAQUE 2 study, which provided for the collection of baseline and 2-year follow-up coronary angiography, coronary IVUS and carotid ultrasound imaging data, was terminated by the sponsor prior to completion due to the discontinuation of the dalcetrapib drug development program. The MHICC-31052012 study allowed for the collection of follow-up imaging and clinical endpoint data from subjects who had successfully undergone baseline IVUS imaging in dal-PLAQUE 2. Data from CAIN-003 and MHICC-31052012 was pooled to support the objective of determining the correlation and clinical relevance of these imaging endpoints. The objectives of the CAIN-003 and MHICC-31052012 study were: - To compare the extent of atherosclerosis present in the coronary vasculature with the extent of atherosclerosis present in the carotid vasculature at a single point in time. - To compare the associations of atherosclerosis burden with coronary risk factors in the coronary arteries and carotid arteries, in multivariable regression. - To compare the rate of atherosclerosis progression or regression in the coronary vasculature with the rate of atherosclerosis progression or regression in the carotid vasculature over a 2-year period. - To determine the correlation between imaging biomarkers and cardiovascular outcomes over a 5-year period.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 1339
• Est. completion date: December 12, 2017
• Est. primary completion date: December 12, 2017
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Male and female patients over the age of 18 years.

2. Patients scheduled for clinically indicated coronary angiography and possible ad hoc percutaneous coronary intervention (PCI) will be evaluated before their scheduled procedure.

3. Written informed consent (approved by the Institutional Review Board [IRB]/Independent Ethics Committee [IEC]) obtained prior to any study specific procedures.

4. Patients considered to be stable at enrollment (at the discretion of the investigator) are eligible provided they meet all other entry criteria.

5. Angiographic inclusion criteria:

• Entire Coronary Circulation: The patient must have angiographic evidence of coronary artery disease as defined by at least one lesion in any of the three major native coronary arteries that has >20% reduction in lumen diameter by angiographic visual estimation or prior history of PCI. This vessel does not need to be the target coronary artery for IVUS. Any vessel with previous PCI may not be used as the target coronary artery.
• Left Main Coronary Artery: The patient must not have > 50% reduction in lumen diameter by visual angiographic estimation.
• Target Coronary Artery: Patient will be required to have one "target" coronary artery for IVUS that has not undergone prior PCI, that is not a candidate to undergo PCI presently or in the next 24 months, and that has not been the cause of a recent myocardial infarction. The proximal 4 cm of the "target" artery in which

IVUS examination will be performed at baseline:

• Must have a diameter stenosis < 50% lumen diameter by visual assessment of the angiogram;
• Must have a reference diameter > 2.5 mm;
• Must be free of filling defects suggestive of thrombus;
• Must not present any anatomical characteristic (such as but not limited to severe tortuosity or calcification) that would impede IVUS interrogation at baseline or follow-up
• Note: a lesion of up to 60% stenosis is permitted, distal to the target segment. A side branch of the target coronary artery for IVUS may not be a target for PCI. Exclusion Criteria:

Subjects presenting with any of the following will not be included in the study:

1. Women of childbearing potential (women who are not surgically sterile or postmenopausal defined as amenorrhea for >12 months) who refuse to undergo a urine or serum pregnancy test immediately prior to baseline and repeat imaging evaluations The urine or serum pregnancy test must be negative prior to imaging evaluations.

2. Previous coronary artery bypass graft (CABG) surgery or probable need for CABG in the next 24 months.

3. Patients who have symptomatic congestive heart failure (CHF) (New York Heart Association [NYHA] Class III or IV) at baseline.

4. Patients with clinically significant valvular heart disease likely to require surgical repair or replacement during the treatment period of the study

5. Any clinically significant medical condition or presence of any laboratory abnormality that is considered by the investigator to be clinically important and could interfere with the conduct of the study.

6. The presence of severe liver disease as defined by the presence of cirrhosis, chronic active hepatitis, or chronic jaundice with hyperbilirubinemia,

7. Patients with eGFR < 45 ml/min prior to baseline imaging procedures, or with nephrotic syndrome

8. Patients with a life expectancy less than 2 years.

9. History of malignancy (except for curatively treated basal cell or squamous cell carcinoma of the skin) during the 3 years prior to the screening.

10. Unable or unwilling to comply with protocol requirements, or deemed by the investigator to be unfit for the study.

Related Conditions & MeSH terms

• Carotid Artery Diseases
• Vascular Disease
• Vascular Diseases

Locations

Country	Name	City	State
Canada	Foothills Medical Centre	Calgary
Canada	Cambridge Cardiac Care	Cambridge	Ontario
Canada	Complexe Hospitalier de la Sagamie	Chicoutimi	Quebec
Canada	Mazankowski Alberta Heart Institute University Of Alberta Hospital ABACUS	Edmonton	Alberta
Canada	Royal Alexandra Hospital	Edmonton	Alberta
Canada	CHUS-Hopital Fleurimont	Fleurimont	Quebec
Canada	CSSS-Hopital de Gatineau, secteur Hull	Gatineau	Quebec
Canada	Q & T Research	Gatineau	Quebec
Canada	Viacar Recherche Clinique	Greenfield Park	Quebec
Canada	Queen Elizabeth II - Health Sciences Centre	Halifax	Nova Scotia
Canada	McMaster Clinic Hamilton General Hospital	Hamilton	Ontario
Canada	KMH Cardiology & Diagnostics Centre	Kitchener	Ontario
Canada	Cite de la Sante	Laval	Quebec
Canada	University Hospital/LHSC	London	Ontario
Canada	CDRC Rive Sud	Longueuil	Quebec
Canada	Foothills Medical Centre	Longueuil	Quebec
Canada	KMH Cardiology & Diagnostics Centre	Mississauga	Ontario
Canada	CHUM - Hopital Hotel-Dieu	Montréal	Quebec
Canada	CUSM Montreal General Hospital	Montréal	Quebec
Canada	Hopital Sacré-Cœur de Montreal	Montréal	Quebec
Canada	Montreal Heart Institute	Montréal	Quebec
Canada	Royal Columbian Hospital	New Westminster	British Columbia
Canada	York PCI Research	Newmarket	Ontario
Canada	Heart Care Research	Oshawa	Ontario
Canada	Ottawa Civic Hospital / University of Ottawa Heart Institute	Ottawa	Ontario
Canada	Institut Universitaire de Cardiologie et de Pneumologie de Québec	Québec	Quebec
Canada	Eastern Regional Health Authority	Saint John's	Newfoundland and Labrador
Canada	Centre Hospitalier Régional de Lanaudière	Saint-Charles-Borromée	Quebec
Canada	Centre de santé et des services sociaux de Beauce	Saint-Georges	Quebec
Canada	St-Jerome Medical Research Inc.	Saint-Jérôme	Quebec
Canada	Royal University Hospital	Saskatoon	Saskatchewan
Canada	Scarborough Cardiology Research	Scarborough	Ontario
Canada	St. Michael's Hospital	Toronto	Ontario
Canada	Sunnybrook Health Science Center	Toronto	Quebec
Canada	University Health Network	Toronto	Ontario
Canada	Centre de santé et de services sociaux de Trois-Rivières	Trois-Rivières	Quebec
Canada	CSSS Vallée de l'Or	Val D'Or	Quebec
Canada	Interventional Cardiology Research, St. Paul's Hospital	Vancouver	British Columbia
Canada	Vancouver General Hospital	Vancouver	British Columbia
Canada	Victoria Heart Institute Foundation (Office)/Royal Jubilee Hospital	Victoria	British Columbia
Germany	Universitatsklinikum Aachen	Aachen
Germany	Klinikum Darmstadt	Darmstadt
Germany	Universitat Heidelberg	Heidelberg
Germany	Universitatsklinikum Ulm	Ulm
Poland	Wojewodzki Szpital	Elblag
Poland	Uniwersyteckie Centrum Kliniczne	Gdansk
Poland	Oddzial Kliniczny Choroby	Krakow
Poland	Samodzielny Publiczny	Lublin
Poland	Szpital Kliniczny	Poznan
Poland	Instytut Kardiologii	Warszawa
Poland	Klinika Kardiologii	Warszawa
Poland	Woskowy Szpital Kliniczny	Wroclaw
Switzerland	Hopitaux Universitaire de Genève	Geneve
United States	University of North Carolina Hospital	Chapel Hill	North Carolina
United States	John Hopkins University Office Capitol Region Research-CAPRES	Columbia	Maryland
United States	Dalla VAMC	Dallas	Texas
United States	Emory University VA Medical Center	Decatur	Georgia
United States	Jim Moran Heart and Vascular Research Institute, Holy Cross Hospital	Fort Lauderdale	Florida
United States	University of southern California	Los Angeles	California
United States	Norton Heart Specialist Springs	Louisville	Kentucky
United States	CV Research at MidMichigan Medical Center Midland	Midland	Michigan
United States	Mercy Health Partners	Muskegon	Michigan
United States	Parkway Cardiology associates	Oak Ridge	Tennessee
United States	Cardiac and Vascular Research Center of Northern Michigan	Petoskey	Michigan
United States	The Valley Hospital	Ridgewood	New Jersey
United States	Sarasota Memorial Hospital	Sarasota	Florida
United States	Florida Cardiovascular Research	Tampa	Florida
United States	University of Toledo Medical Center	Toledo	Ohio
United States	Los Angeles Biomedical Research Institute at Harbor	Torrance	California

Sponsors (1)

Lead Sponsor	Collaborator
Montreal Heart Institute

Countries where clinical trial is conducted

United States,  Canada,  Germany,  Poland,  Switzerland, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	clinical endpoints	Clinical endpoints: death, coronary heart disease, resuscitated cardiac arrest, non-fatal myocardial infarction, stroke, hospitalization for documented acute coronary syndrome (ECG abnormalities without biomarkers), coronary revascularization procedure and carotid artery surgery or angioplasty.	up to five year follow-up
Primary	Nominal change at follow-up from baseline in percent atheroma volume (PAV) obtained using intravascular ultrasound (IVUS)	This endpoint will be the nominal change at follow-up from baseline in percent atheroma volume computed by dividing plaque volume by external elastic membrane volume and then multiplying by 100 at both time points, baseline and 2 year follow-up.	Participants will have a baseline IVUS and a two year follow-up IVUS
Secondary	plaque volume in target coronary artery	This secondary IVUS endpoint will include the nominal change in plaque volume in the target coronary artery, as well as the percent (relative) change in plaque volume.	change at 2 year follow-up from baseline
Secondary	change in plaque volume in the 5-mm sub-segment of target coronary artery	change in plaque volume in the 5-mm sub-segment with the greatest disease burden at baseline, and change in plaque volume in the 5-mm sub-segment with the smallest plaque area at baseline.	change at 2 year follow-up from baseline
Secondary	Total vessel volume in the target coronary artery	Total vessel volume for all anatomically comparable slices in the 30-mm target coronary artery segment and the change in plaque characterization indices.	change at final 2 year follow-up from baseline
Secondary	change in coronary score assessed by quantitative coronary angiography	Evaluation of change in coronary score assessed by quantitative coronary angiography and defined as the per-patient mean of the minimal lumen diameter for all lesions measured. As well evaluation of the cumulative coronary stenosis score (calculated by adding all percent diameter stenoses in standard international units).	change at final 2 year follow-up from baseline
Secondary	nominal change in carotid IMT(CIMT)	This secondary endpoint will be obtained using 2D B-mode carotid ultrasound and will be the nominal change at final follow-up from baseline in carotid IMT(CIMT), where CIMT is computed as the per scan average of the mean IMT values of carotid segments.	change at final 2 year follow-up from baseline