ST-elevation Myocardial Infarction Clinical Trial
— GOODIOfficial title:
Study of Prognostic Value of Copeptin for Myocardial Infarct Size and 6-month Prognosis in Patients With ST-elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: GOOD I Study
ST-elevation myocardial infarction (STEMI) has a serious health threaten to population. PCI, which can timely restore the blood flow to the ischemic myocardium, is a well-proved measure in STEMI management. However, the process of the restoration can induce injury. The phenomenon is defined as ischemia/reperfusion (I/R) injury. The studies indicate that I/R injury accounts for up to 50% of the final myocardial infarct size. However, previous attempts to target known mediators of myocardial I/R injury in patients have been disappointing, leading to calls for a reevaluation of factors affecting myocardial I/R injury [1]. Arginine vasopressin (AVP), that response to acute illness, is unstable and cleared rapidly from the circulation. However, copeptin, the C-terminal portion of provasopressin, is released in equimolar amounts to AVP and is easy to determine. So, copeptin can be a surrogate marker for AVP secretion. Recently, copeptin was found to serve as a potential prognostic biomarker in heart failure and acute myocardial infarction (AMI). AMI can activate the AVP axis, which have a causative role in the evolution of heart failure. Increasing copeptin was shown to correlate with myocardial remodeling, mortality and morbidity. In patients with STEMI, myocardial infarct size is a stronger outcome predictor than LV function, and is related to LV remodeling, which often indicates a significant worse prognosis after AMI. As the gold standard for characterisation of cardiac structure and function, cardiac magnetic resonance (CMR) parameters can serve as surrogate end points in clinical trials of STEMI. We hypothesised that plasma copeptin values, tested before and after PCI, are related to myocardial infarct size, myocardial function both and outcomes at baseline and 6 months follow-up as assessed by CMR in patients with STEMI.
Status | Recruiting |
Enrollment | 275 |
Est. completion date | August 31, 2019 |
Est. primary completion date | February 28, 2019 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 75 Years |
Eligibility |
Inclusion Criteria: 1. chest pain present less than 12 hours from onset of pain to time of catheterization; 2. significant ST-segment elevation (at least 0.1 mV in two or more standard leads or at least 0.2 mV in two or more contiguous precordial leads) or a new left bundle branch block; 3. receiving primary PCI. Exclusion Criteria: 1. Patients with conditions other than STEMI that could cause increased copeptin levels, such as renal dysfunction (eGFR<30 ml/min), liver failure, respiratory tract infection, stroke, sepsis, hyponatremia (Serum sodium concentration<135mmol/L), central diabetes insipidus or malignancy; 2. Patients with contraindications to perform cardiac magnetic resonance; 3. Patients with cardiogenic shock (Killip class IV); 4. Patients in whom reperfusion therapy failed; 5. Patients who were referred for emergency coronary artery bypass grafting (CABG) in view of unfavourable coronary anatomy. |
Country | Name | City | State |
---|---|---|---|
China | Shengjing Hospital of China Medical University | Shenyang | Liaoning |
Lead Sponsor | Collaborator |
---|---|
Shengjing Hospital |
China,
Ellis SG, Tendera M, de Belder MA, van Boven AJ, Widimsky P, Janssens L, Andersen HR, Betriu A, Savonitto S, Adamus J, Peruga JZ, Kosmider M, Katz O, Neunteufl T, Jorgova J, Dorobantu M, Grinfeld L, Armstrong P, Brodie BR, Herrmann HC, Montalescot G, Neumann FJ, Effron MB, Barnathan ES, Topol EJ; FINESSE Investigators.. Facilitated PCI in patients with ST-elevation myocardial infarction. N Engl J Med. 2008 May 22;358(21):2205-17. doi: 10.1056/NEJMoa0706816. — View Citation
O'Malley RG, Bonaca MP, Scirica BM, Murphy SA, Jarolim P, Sabatine MS, Braunwald E, Morrow DA. Prognostic performance of multiple biomarkers in patients with non-ST-segment elevation acute coronary syndrome: analysis from the MERLIN-TIMI 36 trial (Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndromes-Thrombolysis In Myocardial Infarction 36). J Am Coll Cardiol. 2014 Apr 29;63(16):1644-53. doi: 10.1016/j.jacc.2013.12.034. Erratum in: J Am Coll Cardiol. 2014 Jun 17;63(23):2642. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Major adverse cardiovascular events (MACE) | Composite of MACE including cardiac death, non-fatal myocardial reinfarction, unplanned repeat revascularization, congestive heart failure or angina requiring rehospitalization or an emergency room visit, ventricular fibrillation or ventricular tachycardia with hemodynamic instability | 6 months | |
Secondary | All-cause death | All-cause death | 6 months | |
Secondary | Cardiac death | Cardiac death | 6 months | |
Secondary | unplanned repeat revascularization | unplanned repeat revascularization which included any unplanned repeat PCI or surgical bypass of target or non-target vessels | 6 months | |
Secondary | congestive heart failure requiring rehospitalization or an emergency room visit | congestive heart failure requiring rehospitalization or an emergency room visit | 6 months | |
Secondary | angina requiring rehospitalization or an emergency room visit | angina requiring rehospitalization or an emergency room visit | 6 months | |
Secondary | ventricular fibrillation or severe ventricular tachycardia | ventricular fibrillation or severe ventricular tachycardia with hemodynamic instability occurring more than 2 hours after PCI | 6 months | |
Secondary | acute heart failure during the index hospitalization | acute heart failure during the index hospitalization | 6 months | |
Secondary | in-stent stent thrombosis | acute, subacute or chronic in-stent stent thrombosis | 6 months | |
Secondary | contrast-induced nephropathy | Contrast-induced nephropathy was de?ned as an increase in serum creatinine concentration =0.5 mg/dl (44.2 mmol/l) or =25% above baseline 72 h after exposure to the contrast medium. | 6 months | |
Secondary | ischemia stroke | ischemia stroke was defined as an acute event of non-hemorrhagic cerebrovascular origin causing focal or global neurologic dysfunction lasting >24 h, which was confirmed by both clinical and radiographic criteria. | 6 months | |
Secondary | Bleeding Academic Research Consortium Definition for Bleeding: type 3 or 5 | Bleeding Academic Research Consortium Definition for Bleeding: Type 3 Type 3a Overt bleeding plus hemoglobin drop of 3 to 5 g/dL* (provided hemoglobin drop is related to bleed) Any transfusion with overt bleeding Type 3b Overt bleeding plus hemoglobin drop 5 g/dL* (provided hemoglobin drop is related to bleed) Cardiac tamponade Bleeding requiring surgical intervention for control (excluding dental/nasal/skin/hemorrhoid) Bleeding requiring intravenous vasoactive agents;Type 3c Intracranial hemorrhage (does not include microbleeds or hemorrhagic transformation, does include intraspinal) Subcategories confirmed by autopsy or imaging or lumbar puncture Intraocular bleed compromising vision Type 5: fatal bleeding Type 5a Probable fatal bleeding; no autopsy or imaging confirmation but clinically suspicious Type 5b Definite fatal bleeding; overt bleeding or autopsy or imaging confirmation | 6 months | |
Secondary | Seattle angina questionnaire (SAQ) | Seattle angina questionnaire (SAQ) | 6 months | |
Secondary | Quality of life (EQ-5D) | Quality of life (EQ-5D) | 6 months | |
Secondary | Depression (PHQ-8) | Depression (PHQ-8) | 6 months | |
Secondary | Stress (Chinese 14-item PSS) | Stress (Chinese 14-item PSS) | 6 months | |
Secondary | Cognitive function (MMSE) | Cognitive function (MMSE) | 6 months | |
Secondary | myocardial infarct size | myocardial infarct size | 6 months |
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