PIONEER Trial:Hemodynamic Support With ECMO and IABP in Elective Complex High-risk PCI

Coronary Artery Disease Clinical Trial

Official title:

A Prospective, Multicenter, Randomized Clinical Trial of Hemodynamic Support With ECMO and IABP Versus IABP Alone, in Complex High-risk Patients Undergoing Elective PCI(PIONEER Trial)

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT04045873
• Other study ID #: KY20192060-F-1
• Status: Not yet recruiting
• Phase: N/A
• Start date: December 2019
• Est. completion date: June 2024

Study information

• Verified date: July 2019
• Source: Xijing Hospital
• Contact: Yi Liu, MD, PhD
• Phone: 86-02984775183
• Email: liuyimeishan[@]hotmail.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

To determine whether hemodynamic support combining VA-ECMO with IABP could mitigate the rates of Major Adverse Cardiovascular and Cerebrovascular Events (MACCEs), compared with IABP support alone, in patients undergoing elective and high-risk PCI.

Description:

Percutaneous Coronary Intervention (PCI) supported by mechanical circulatory device may be a viable alternative for these patients with complex coronary artery disease combined with multiple comorbidities and poor hemodynamics. Extracorporeal Membrane Oxygenation (ECMO) can direct blood flow out of the body, oxygenate it, and then return it, to either completely or partially replace the function of the heart and lungs, and potentially increase the likelihood of functional recovery. Limitations of ECMO include lack of direct LV unloading, and increased LV afterload with subsequent LV overload, which in turn can increase myocardial oxygen demand and therefore limit any cardioprotective benefits . Measures to concurrently decrease LV afterload during ECMO, such as use of an Intra-Aortic Balloon Pump (IABP), may in theory offset some of the disadvantages of ECMO. To date, ECMO has most commonly been used in patients suffering from cardiac arrest and cardiogenic shock . As far as we are aware, there exist very limited reported data from monocentric observational studies and individual case reports on the use of ECMO for elective, high-risk PCI in the literature . More importantly, no previous randomized studies to evaluate the safety and efficacy of a strategy combining VA-ECMO and IABP during high-risk PCI have been conducted to date. Most importantly, the strategy of combined VA-ECMO and IABP has never been investigated in any randomized trial that we could find.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 306
• Est. completion date: June 2024
• Est. primary completion date: July 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 85 Years

Eligibility

Inclusion Criteria:

• Patients aged from 18 years to 85 years who meet any one of the following criteria

1. Unprotected left main coronary artery disease with severe LV dysfunction (EF<35% or NYHA grade ? and ?).

2. Unprotected left main coronary artery disease without severe LV dysfunction (LVEF>35% or NYHA ? and ?) must meet at least two of the complex procedure criteria (see Section II below).

3. 3-vessel disease with severe LV dysfunction (EF<35% or NYHA grade ? and ?) must meet at least two of the complex procedure criteria (see Section II below).

Criteria Defining a Complex Procedure

1. Bifurcation requiring PCI in two branches (including PTCA or stenting).

2. Calcification requiring atherectomy.

3. Tortuosity requiring device assistance.

4. Difficult CTO(J-CTO score=2).

Exclusion Criteria:

1. Acute myocardial infarction within the previous 48 hours.

2. Pre-procedure cardiac arrest within 24 hours of enrollment requiring CPR.

3. Cardiogenic shock.

4. Complications of acute myocardial infarction (including ventricular septal defect, severe mitral regurgitation, and intractable ventricular arrhythmias).

5. Contraindications to IABP or ECMO use, including significant iliac or femoral arterial disease and more than mild aortic regurgitation as seen on echocardiography.

6. Bleeding diathesis or warfarin therapy with an international normalized ratio greater than 2.5.

7. Active internal bleeding (including menstruation) within the past month.

8. Recent ischemic stroke within the past month diagnosed by CT or MRI.

9. Previous hemorrhagic stroke diagnosed by CT or MRI.

10. Allergy to aspirin, clopidogrel, heparin, ticagrelor or glycoprotein IIb/ IIIa inhibitors; thrombocytopenia.

11. Pregnancy.

12. Current enrollment in any other study.

Related Conditions & MeSH terms

• Coronary Artery Disease
• Coronary Disease
• Heart Failure
• Myocardial Ischemia

Intervention

Device:
• extracorporeal membrane oxygenation
The VA-ECMO procedure will be performed by femoral artery access, and the IABP will then be implanted in the contralateral femoral artery.

Locations

Country	Name	City	State
n/a

Sponsors (6)

Lead Sponsor	Collaborator
Xijing Hospital	Beijing Anzhen Hospital, Bethune International Peace Hospital, General Hospital of Northern Theater Command, The First Affiliated Hospital of Zhengzhou University, The Second Affiliated Hospital of Harbin Medical University

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The primary efficacy end point is the composite rate of MACCE at peri-procedure, in-hospital, or within a 30-day follow-up post-discharge.	The composite primary end point components include angiographic failure rates of PCI, all-cause death, myocardial infarction, stroke or transient ischemic attack, any repeat revascularization procedure, acute renal insufficiency, major vascular complications, severe intraprocedural hypotension requiring therapy, cardiopulmonary resuscitation, or ventricular tachycardia requiring cardioversion.	30 days
Secondary	The rate of complete revascularization		intra-procedure
Secondary	intra-procedure hemodynamics		intra-procedure
Secondary	vascular access site and access-related complications		intra-procedure
Secondary	major or life-threatening or disabling bleeding		30 days
Secondary	stroke or transient ischemic attack		30 days
Secondary	acute kidney injury		30 days
Secondary	MACCE at 6 months		6 months
Secondary	MACCE at 1 year		1 year
Secondary	MACCE at 2 years		2 years
Secondary	MACCE at 3 years		3 years