Heart attacks are caused by a blood clot blocking the blood vessels of the heart, preventing blood getting to the heart muscle. Opening up the artery with a balloon (angioplasty) and a small mesh tube (stent) although life saving can cause this clot to break up and get washed downstream, which can make the heart attack worse. The investigators can measure the amount of damage caused to the microcirculation by calculating the IMR (Index of Microcirculatory resistance).
This can be measured by a wire in the coronary artery with a pressure sensor at the tip. If the IMR is elevated, it is suggestive of extensive microcirculatory damage. A clot dissolving medicine can be administered in the artery to try and reduce the IMR which can reduce damage to the heart muscle and improve outcomes.
Impaired microcirculatory perfusion in patients as a result of ST-elevation myocardial infarction (STEMI) is associated with poor clinical outcomes. This project seeks to identify patients with impaired microcirculatory perfusion after STEMI and to assess whether acute improvement in microcirculatory perfusion in these patients by the use of intracoronary thrombolytic therapy results in improved clinical outcomes.
Condition or disease | Intervention/treatment | Phase |
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STEMI Elevated IMR (>32) | Drug: Tenecteplase (1/3 systemic weight based dose) Other: Sterile water for injection (WFI) Drug: Tenecteplase (1/6 systemic weight based dose) | Phase 3 |
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 506 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Intervention Model Description: | Multi-Centre double-blind, placebo controlled randomised phase IIIb clinical trial, stratified and balanced between groups on important prognostic factors. |
Masking: | Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) |
Masking Description: | All parties involved will be blinded. |
Primary Purpose: | Other |
Official Title: | A Randomised Trial to Evaluate the Efficacy of Low-dose Intracoronary Tenecteplase in ST-Elevation Myocardial Infarction (STEMI) Patients With High Microvascular Resistance Post-percutaneous Coronary Intervention (PCI). |
Estimated Study Start Date : | May 1, 2021 |
Estimated Primary Completion Date : | December 31, 2022 |
Estimated Study Completion Date : | December 31, 2024 |
Arm | Intervention/treatment |
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Experimental: Tenecteplase (1/3 systemic weight based dose)
Tenecteplase will be reconstituted in 20mL sterile water for injection at 1/3 of the weight based dose, and administered by intracoronary infusion over 3 minutes.
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Drug: Tenecteplase (1/3 systemic weight based dose)
50mg reconstituted to 20mL for intracoronary infusion at 1/3 weight based dose.
Other Name: TNKase
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Placebo Comparator: Sterile Water for injection (WFI)
Water for injection will be prepared to 20mL over an equivalent time period to the reconstitution time of the experimental arm, in order to maintain the blind, and administered by intracoronary infusion over 3 minutes.
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Other: Sterile water for injection (WFI)
Placebo comparative arm.
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Experimental: Tenecteplase (1/6 systemic weight based dose)
Tenecteplase will be reconstituted in 20mL sterile water for injection at 1/6 of the weight based dose, and administered by intracoronary infusion over 3 minutes.
|
Drug: Tenecteplase (1/6 systemic weight based dose)
50mg reconstituted to 20mL for intracoronary infusion at 1/6 weight based dose.
Other Name: TNKase
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Index of microcirculatory resistance (IMR) measurement assessed by coronary pressure wire data output review.
This is a simple unit scale, with a higher number indicating a worse outcome with a score of more than 25 indicating abnormal microcirculatory function in the heart.
Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Exclusion Criteria:
At the time of screening and/or prior to randomisation, no known;
Participation in any investigational study in the previous 30 days
Other exclusion criteria:
(Dose Finding and Cardiac MRI cohort only) Presence of contraindications to contrast enhanced MRI including severe claustrophobia, pregnancy, pacemakers, non-MRI compatible aneurysm clips, defibrillators and estimated glomerular filtration rate of <30mL/min.
(At time of PCI)
Contact: Martin Ng, MBBS (Hons) | +614 3407 8507 | martin.ng@sydney.edu.au | |
Contact: Rebecca Mister | +612 9562 5000 ext 5342 | RESTORE-MI@ctc.usyd.edu.au |
Australia, New South Wales | |
Concord Repatriation General Hospital | |
Camperdown, New South Wales, Australia, 2050 | |
Contact: Andy Yong, MBBS +614 0130 1790 sze.yong@sydney.edu.au | |
Royal Prince Alfred Hospital | |
Camperdown, New South Wales, Australia, 2050 | |
Contact: Martin Ng, MBBS (Hons) +614 3407 8507 martin.ng@sydney.edu.au |
Study Chair: | Martin Ng, MBBS (Hons) | Royal Prince Alfred Hospital, Sydney, Australia | |
Study Chair: | Andy Yong, MBBS | Concord Repatriation General Hospital | |
Study Chair: | Anthony Keech, MBBS | National Health and Medical Research Council, Australia | |
Study Chair: | William Fearon, MD | Stanford University |
Tracking Information | |||||||||||||
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First Submitted Date ICMJE | May 6, 2019 | ||||||||||||
First Posted Date ICMJE | June 26, 2019 | ||||||||||||
Last Update Posted Date | April 27, 2021 | ||||||||||||
Estimated Study Start Date ICMJE | May 1, 2021 | ||||||||||||
Estimated Primary Completion Date | December 31, 2022 (Final data collection date for primary outcome measure) | ||||||||||||
Current Primary Outcome Measures ICMJE |
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Original Primary Outcome Measures ICMJE |
To compare the number of participants who experience cardiovascular mortality and rehospitalisation for heart failure at 24 months in those given tenecteplase with those given placebo. [ Time Frame: 24 months ] Cardiovascular mortality and rehospitalisation for heart failure assessed by medical record review.
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Change History | |||||||||||||
Current Secondary Outcome Measures ICMJE |
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Original Secondary Outcome Measures ICMJE | Same as current | ||||||||||||
Current Other Pre-specified Outcome Measures |
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Original Other Pre-specified Outcome Measures |
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Descriptive Information | |||||||||||||
Brief Title ICMJE | A Study of Low-dose Intracoronary Thrombolytic Therapy in STEMI (Heart Attack) Patients. | ||||||||||||
Official Title ICMJE | A Randomised Trial to Evaluate the Efficacy of Low-dose Intracoronary Tenecteplase in ST-Elevation Myocardial Infarction (STEMI) Patients With High Microvascular Resistance Post-percutaneous Coronary Intervention (PCI). | ||||||||||||
Brief Summary |
Heart attacks are caused by a blood clot blocking the blood vessels of the heart, preventing blood getting to the heart muscle. Opening up the artery with a balloon (angioplasty) and a small mesh tube (stent) although life saving can cause this clot to break up and get washed downstream, which can make the heart attack worse. The investigators can measure the amount of damage caused to the microcirculation by calculating the IMR (Index of Microcirculatory resistance). This can be measured by a wire in the coronary artery with a pressure sensor at the tip. If the IMR is elevated, it is suggestive of extensive microcirculatory damage. A clot dissolving medicine can be administered in the artery to try and reduce the IMR which can reduce damage to the heart muscle and improve outcomes. Impaired microcirculatory perfusion in patients as a result of ST-elevation myocardial infarction (STEMI) is associated with poor clinical outcomes. This project seeks to identify patients with impaired microcirculatory perfusion after STEMI and to assess whether acute improvement in microcirculatory perfusion in these patients by the use of intracoronary thrombolytic therapy results in improved clinical outcomes. |
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Detailed Description | Patients presenting to the participating hospitals with a heart attack will be approached to participate in the study. After angioplasty has been performed, the IMR will be measured in the infarct related artery. If the IMR is >32 patients will be randomised to receive intracoronary clot dissolving therapy in the form of low, or very low dose tenecteplase (TNK) or water as a placebo. Patients who have an IMR ≤32 will be followed up in a registry. Cardiac enzymes will be measured at baseline and discharge. Randomised participants will receive a cardiac MRI at discharge (3-7 days post primary PCI) and at 6 months post PCI. All participants will be followed up at 30 days, and 6, 12 and 24 months following discharge. | ||||||||||||
Study Type ICMJE | Interventional | ||||||||||||
Study Phase ICMJE | Phase 3 | ||||||||||||
Study Design ICMJE | Allocation: Randomized Intervention Model: Parallel Assignment Intervention Model Description: Multi-Centre double-blind, placebo controlled randomised phase IIIb clinical trial, stratified and balanced between groups on important prognostic factors. Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)Masking Description: All parties involved will be blinded. Primary Purpose: Other
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Condition ICMJE |
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Intervention ICMJE |
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Study Arms ICMJE |
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Publications * | Not Provided | ||||||||||||
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline. |
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Recruitment Information | |||||||||||||
Recruitment Status ICMJE | Not yet recruiting | ||||||||||||
Estimated Enrollment ICMJE |
506 | ||||||||||||
Original Estimated Enrollment ICMJE |
800 | ||||||||||||
Estimated Study Completion Date ICMJE | December 31, 2024 | ||||||||||||
Estimated Primary Completion Date | December 31, 2022 (Final data collection date for primary outcome measure) | ||||||||||||
Eligibility Criteria ICMJE |
Inclusion Criteria:
Exclusion Criteria: At the time of screening and/or prior to randomisation, no known;
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Sex/Gender ICMJE |
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Ages ICMJE | 18 Years and older (Adult, Older Adult) | ||||||||||||
Accepts Healthy Volunteers ICMJE | No | ||||||||||||
Contacts ICMJE |
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Listed Location Countries ICMJE | Australia | ||||||||||||
Removed Location Countries | United States | ||||||||||||
Administrative Information | |||||||||||||
NCT Number ICMJE | NCT03998319 | ||||||||||||
Other Study ID Numbers ICMJE | CTC0150 | ||||||||||||
Has Data Monitoring Committee | No | ||||||||||||
U.S. FDA-regulated Product |
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IPD Sharing Statement ICMJE |
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Responsible Party | University of Sydney | ||||||||||||
Study Sponsor ICMJE | University of Sydney | ||||||||||||
Collaborators ICMJE | Genentech, Inc. | ||||||||||||
Investigators ICMJE |
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PRS Account | University of Sydney | ||||||||||||
Verification Date | April 2021 | ||||||||||||
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP |