A Phase 4 interventional study of 1 month DAPT and 6 months DAPT in Coronary Disease, Drug Eluting Stent and Percutaneous Coronary Intervention, sponsored by Shanghai MicroPort Medical (Group) Co., Ltd.. Status unknown at 1 site in China. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2020-09-09.
Sponsored by Shanghai MicroPort Medical (Group) Co., Ltd. · Phase 4, Interventional, and Treatment
This study is to assess the clinical non-inferiority of 1 month (short-term) vs 6 months (long-term) of dual anti-platelet therapy in patients undergoing percutaneous intervention implanted sirolimus -eluting stent with abluminal grooves containing a biodegradable polymer in High Bleeding Risk patients with coronary artery disease.
This is a prospective, double -blind,multi-center,randomized controlled trial. Approximately 1,720 subjects in high bleeding risk with coronary artery disease will be enrolled in no more than 40 research centers in China. All participants met the inclusion criteria will be 1:1 randomized to 1 month or 6months of DAPT after implanting Firehawk™ coronary stent. Clinical follow-up will be carried out at 30 days, 6 months, 12 months, 2 years after index procedure.The primary study endpoint is Net Adverse Clinical and Cerebral Events (NACCE), a composite of all-cause death, myocardial infarction (MI), cerebral vascular accident (CVA) and major bleeding ([BARC] definition) at 12 months. Subjects that complete of 12 months follow-up will be regarded as having completed the primary endpoint. The secondary study endpoints contain cost-effectiveness at 12 months, ARC defined stent thrombosis (ST) ; NACCE ;major adverse cardiovascular events (MACE),major adverse cardiovascular and cerebral events (MACCE),target lesion revascularization (TLR),target vessel failure(TVF) , major bleeding at 30 days,6,12 and 24 months of follow-up.
General Inclusion Criteria:
Subjects can endure 6 months dual anti-platelet therapy, and met one or more criteria as the following:
1.Age ≥ 75years; 2.Subjects with hemoglobin\<10g/dL, or subjects received transfusion therapy 4 weeks ago; 3.Subjects with renal insufficiency (eGFR \< 60 ml / min); 4. Subjects with HAS-BLED score ≥3.0; 5.Femal patients with acute cononary syndrome; 6.BMI \< 18.5 Kg/M2; 7.Subjects with congestive heart failure and with LVEF30%-50%; 8.Subjects had a history of hospitalization due to bleeding; 9.Subjects with thrombocytopenia (platelet \< 100,000 / mm3); 10.Subjects had a histroy of intracranial hemorrhage; 11.Subjects had a histroy of intracranial ischemia stroke in 6 months; 12.Subjects plan to receive non-steroidal anti-inflammatory or steroid treatment for more than 30 days after the baseline PCI; 14.Subjects were expected to receive additional treatment after PCI and cannot undergo long-term DAPT therapy; 15.Subjects had a history of stomach ulcers or active ulcers.
Angiographic Inclusion Criteria
Clinical Exclusion Criteria:
Subjects recently suffer from MI (within 4 week) and ECG changes/clinical symptoms consistent with AMI, or accompanied with increased cardiac biomarkers (CK-MB, CK, TNT or TNI) and at least one of the following :
If CK-MB or CK was not detected, but cTN> 1ULN, and at least one of the following:
Angiographic Exclusion Criteria (visual estimate):
After implantation of Firehawk coronary stents, 860 subjects in intervention group will be given dual anti-platelet therapy (DAPT) including aspirin and clopidogrel for 1 month, then will be given aspirin and placebo for next 5 months.
Drug: 1 month DAPT
After implantation of Firehawk coronary stents, 860 subjects in control group will be given dual anti-platelet therapy (DAPT) including aspirin and clopidogrel for 6 months.
Drug: 6 months DAPT
Subjects will continue DAPT with clopidogrel and Aspirin (ASA) up to 1 month, after which patients will be given ASA and placebo in next 5 months and then continue on monotherapy with ASA only, unless contraindications for ASA emerge.
Subjects will continue DAPT with clopidogrel and Aspirin (ASA) up to 6 months, after which patients will continue on monotherapy with ASA only, unless contraindications for ASA emerge.
Net Adverse Clinical and Cerebral Events (NACCE)
A composite of all-cause death, MI, cerebral vascular accident (CVA) and major bleeding at 18 months
Time frame: At 12 months after index procedure
Target Vessel Revascularization (TVR)
Time frame: In hospital and at 30 days,6, 12 and 24 months after index procedure
Target lesion Revascularization (TLR)
Time frame: In hospital and at 30 days,6, 12 and 24 months after index procedure
Target Vessel Failure (TVF)
Time frame: In hospital and at 30 days,6, 12 and 24 months after index procedure
Target Lesion Failure (TLF)
Time frame: In hospital and at 30 days,6, 12 and 24 months after index procedure
Stent Thrombosis (per ARC definition)
the definite and probable stent thrombosis
Time frame: In hospital and at 30 days,6, 12 and 24 months after index procedure
Major Adverse Cardiac and Cerebral Events(MACCE)
Time frame: In hospital and at 30 days,6, 12 and 24 months after index procedure
Net Adverse Clinical and Cerebral Events (NACCE)
Time frame: In hospital and at 30 days,6, 12 and 24 months after index procedure
Myocardial Infarction (MI,including Q-wave MI and non Q-wave MI)
Time frame: In hospital and at 30 days,6, 12 and 24 months after index procedure
Death (All cause, Cardiac, Non-cardiac)
Time frame: In hospital and at 30 days,6, 12 and 24 months after index procedure
Cardiac Death
Time frame: In hospital and at 30 days,6, 12 and 24 months after index procedure
Non-Cardiac Death
Time frame: In hospital and at 30 days,6, 12 and 24 months after index procedure
Major Bleeding
\[BARC\] definition
Time frame: In hospital and at 30 days,6, 12 and 24 months after index procedure
Cost-Effectiveness Ratio (CER)
CER = \[total medical care costs of anti-platelet therapy\] / \[number of participants without net adverse clinical and cerebral events (NACCE)\]
Time frame: At 12 months after index procedure
Plan to share: Yes — Individual participant data that underlie the results reported in the article, after deidentification (text, tables, figures, and appendices) will be shared. Additionally, study protocol will be available. The data will become available for the beginning 3 months and ending 5 years following article publication. The access criteria are as follow: (With) Researchers who provide a methodologically sound proposal. (For the analysis) to achieve aims in the approved proposal. (Requisite mechanism) Proposals should be directed to mzheng@microport.com. To gain access, data requestors will need to sign a data access agreement. Data are available for 5 years at a third party website (Link to be included). If the data sharing plan changes after registration, this should be reflected in the statement submitted and published with the manuscript, and updated in the registry record.
Supporting information: Study protocol
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Shanghai MicroPort Medical (Group) Co., Ltd.