Clinical Trial Details
— Status: Completed
Administrative data
NCT number |
NCT05355532 |
Other study ID # |
CMVO-SNP-2022 |
Secondary ID |
|
Status |
Completed |
Phase |
|
First received |
|
Last updated |
|
Start date |
April 11, 2022 |
Est. completion date |
March 25, 2023 |
Study information
Verified date |
April 2022 |
Source |
Privolzhsky Research Medical University |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Observational
|
Clinical Trial Summary
Myocardial infarction (MI) remains one of the most common causes of death. Percutaneous
coronary intervention (PCI) is the main treatment option to restore blood flow through the
infarction-related coronary artery (IRA) in MI patients. Performing PCI significantly reduces
mortality, but in 5-10% cases, PCI is complicated by the development of coronary
microvascular obstruction (CMVO, "no-reflow"). CMVO is defined as the absence of adequate
myocardial perfusion, despite the restoration of the IRA lumen. The development of CMVO
significantly worsens the prognosis and increases mortality.
CMVO has a complex pathogenesis and is development due to following mechanisms: distal
microembolism, ischemia-reperfusion injury, persistent endothelial dysfunction, and
individual predisposition. These mechanisms can be implemented simultaneously and have
different severity. The most significant predictors of CMVO occurrence are: age, time from
pain onset to reperfusion, severity of acute heart failure, ineffective thrombolytic therapy,
collateral blood flow according to the Rentrop classification, severity of IRA thrombosis
according to Thrombolysis in Myocardial Infarction (TIMI) thrombus grade, initial IRA blood
flow according to TIMI flow grade, implantation of 3 or more stents, direct IRA stenting,
neutrophil and blood glucose levels.
Difficulties in CMVO predicting are caused by the pathogenetic heterogeneity of this
complication. Even the best models are moderately accurate. This can be explained by the fact
that the models don't use genetic factors that determine endothelial function,
microcirculation, hemostasis, and inflammation. Identification of the genetic determinants of
the CMVO development can help create a new diagnostic system for CMVO predicting.
Description:
The aim of the study to identify the genetic determinants of the coronary microvascular
obstruction development during percutaneous coronary interventions in myocardial infarction
patients. The study investigates the role of some variants of single nucleotide polymorphism
(SNP) as predictors of CMVO development. Selected SNPs that are associated with the
mechanisms of CMVO development (according to literature). Hypothesis: selected SNPs are
independent genetic predictors of the development of CMVO during PCI in MI patients.
Study design: matched case-control study. Sample size: 80 patients. Patients must have
inclusion criteria, haven't exclusion criteria, and sign an informed consent. Division into 2
groups in the ratio 1:1. Group 1 (CMVO+): 40 patients with MI who were detected the CMVO
after PCI. The second group (CMVO-, control): 40 patients with MI who weren't detected CMVO
after PCI. Groups are matched by sex and age. The sample size (80 patients) was determined in
accordance with the following parameters: alpha error - 5%, study power - 80%, group size
ratio - 1:1, minimum odds ratio for detection - 4.0, prevalence SNP in the population -
12-69% (average 50%).
CMVO (no-reflow) is defined as inadequate myocardial perfusion after successful mechanical
restoration of blood flow through the IRA (according to the 2017 European Society of
Cardiology STEMI guidelines). CMVO criteria (there must be at least one criterion): 1) IRA
blood flow is less than 3 points according to TIMI flow grade; 2) myocardial perfusion less
than 2 points according to Myocardial blush grade (MBG). Other causes of IRA obstruction
(spasm, dissection, thromboembolism) must be excluded.
Research stages: 1) assessment of inclusion / exclusion criteria; 2) signing informed
consent; 3) taking blood for genetic analysis (performed in the operating room immediately
after PCI); 4) processing of blood samples and their transportation to the laboratory; 5)
filling out the patient's register card (contains information about the treatment and
outcomes); 6) performing genetic analysis; 7) statistical processing of the obtained results.
The registration card is filled in at the end of hospitalization. Purpose: 1) comparison of
SNP variants and outcomes; 2) multivariate analysis of SNP variants and other CMVO
predictors. The card contains the following data: information about PCI, risk factors for the
CMVO development, laboratory data (general blood count, biochemical blood test, etc.),
examination data (ECG, ECG monitoring, echocardiography, six-minute walk test), information
about complications and outcomes. These laboratory tests and instrumental studies are used in
accordance with routine hospital protocols for the treatment of MI patients (the using is not
associated with the investigation).
Venous peripheral blood is used for genetic testing. Blood sampling is performed directly in
the operating room after PCI. Selected SNPs from the "CardioGenetics Hypertension" panel,
"CardioGenetics Thrombophilia" panel and "Genetics of Folate Metabolism" panel from the
"DNA-Technology" company (Russia). Also used a set of reagents for the detection of Lys198Asn
polymorphism in the EDN1 gene "SNP-Express-Cardiogenetics RT" from "Litekh" Company (Russia).
SNPs are determined by real-time polymerase chain reaction with high resolution melt curve
analysis using TaqMan fluorescent probes. The following SNPs are analyzed (SNP identifier and
gene): rs4961 (ADD1); rs699 и rs4762 (AGT); rs5186 (AGTR1); rs1403543 (AGTR2); rs1799998
(CYP11B2); rs5443 (GNB3); rs2070744 и rs1799983 (eNOS); rs1799963 (F2); rs6025 (F5); rs6046
(F7); rs5985 (F13); rs1800790 (FGB); rs1126643 (ITGA2-α2); rs5918 (ITGB3-β3); rs1799762
(PAI-1); rs1801133 (MTHFR); rs1801131 (MTHFR); rs1805087 (MTR); rs1801394 (MTRR); rs5370
(EDN1).
Expected results: it will be proved or disproved that some variants of SNP are independent
predictors of the development of CMVO during PCI in patients with myocardial infarction.