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Candesartan for Prevention of Cardiovascular Events After Cypher or Taxus Coronary Stenting (4C) Trial

This study has been completed.
Sponsor:
Collaborators:
The 4C trial bureau
Japan Heart Foundation
Information provided by (Responsible Party):
Hisao Ogawa, Kumamoto University
ClinicalTrials.gov Identifier:
NCT00139386
First received: August 29, 2005
Last updated: April 17, 2013
Last verified: April 2013

August 29, 2005
April 17, 2013
October 2005
April 2009   (final data collection date for primary outcome measure)
The primary endpoint is a composite of: 1)any cause mortality and 2)cardiovascular events (non-fatal MI, drug-resistant AP required hospital admission, heart failure required hospital admission and stroke) [ Time Frame: 3 years ] [ Designated as safety issue: No ]
  • The primary endpoint is a composite of
  • - sudden death,
  • - cardiovascular death,
  • - nonfatal myocardial infarction,
  • - recurrent symptomatic myocardial ischemia,
  • - congestive heart failure,
  • - stroke
  • - any cause mortality,
Complete list of historical versions of study NCT00139386 on ClinicalTrials.gov Archive Site
  • Target lesion revascularization [ Time Frame: 3 years ] [ Designated as safety issue: No ]
  • Binary restenosis [ Time Frame: 3 years ] [ Designated as safety issue: No ]
  • Newly onset diabetes [ Time Frame: 3 years ] [ Designated as safety issue: No ]
  • Newly onset atrial fibrillation [ Time Frame: 3 yeard ] [ Designated as safety issue: No ]
  • Each of the primary endpoint events [ Time Frame: 3 years ] [ Designated as safety issue: No ]
    All cause of death, cardiovascular death, non-fatal myocardial infarction, unstable angina required admission, heart failure required admission and stroke
  • Major adverse cardiac-related events [ Time Frame: 3 years ] [ Designated as safety issue: No ]
    A composite of cardiovascular death, non-fatal myocardial infarction, unstable angina required admission and heart failure required admission
  • Major cardiac-related events [ Time Frame: 3 years ] [ Designated as safety issue: No ]
    A composite of non-fatal myocardial infarction, unstable angina required admission and heart failure required admission
The secondary endpoint is target lesion revascularization rate.
Not Provided
Not Provided
 
Candesartan for Prevention of Cardiovascular Events After Cypher or Taxus Coronary Stenting (4C) Trial
Effects of Candesartan Cilexetil on Cardiovascular Events in Japanese Patients With Hypertension After Sirolimus- or Paclitaxel-Eluting Stents Implantation

Candesartan is effective in preventing cardiovascular events in patients without restenosis after coronary angioplasty. Therefore, the investigators hypothesized that candesartan after drug-eluting stent (DES) implantation was also effective in preventing cardiovascular events.

The purpose of this study is to investigate whether an angiotensin II receptor blocker, candesartan, is effective in reducing the incidence of cardiovascular events after drug-eluting stent implantation.

It was reported that low-dose angiotensin II receptor blocker, candesartan, was effective to prevent cardiovascular events in patients with coronary artery disease treated with coronary angioplasty (Am Heart J 146:E20, 2003). In this study, patients without significant coronary stenosis on follow-up angiography 6 months after intervention were randomly assigned into a candesartan group (baseline treatment plus candesartan 4 mg/d) or a control group (baseline treatment alone). It is well known that patients treated with drug-eluting stents (DES) have lower restenosis rate as compared with those with bare metal stents. Therefore, we hypothesized that candesartan started immediately after DES implantation was effective to prevent cardiovascular events.

The primary endpoint is a composite of any cause death and cardiovascular events (nonfatal myocardial infarction, recurrent symptomatic myocardial ischemia, congestive heart failure, and stroke). The secondary endpoints are target lesion revascularization, binary restenosis, newly onset diabetes and newly onset of atrial fibrillation.

Patient population which needs to prove the hypothesis is estimates to be 1,130 cases in total (565 cases in each group). We set the parameters which are needed to calculate the number of study patients as follows; a drop out rate 10%, an event rate of the primary end point for 3 years 20%, a risk reduction rate brought by candesartan 25%, a statistical power 90% and a two-sided significance level 0.05. We assumed the event rate from the study which was conducted to prove the effects of statins after PCI in Japan named MUSASHI-PCI. Also the risk reduction rate from two major RCTs of candesartan conducted in Japan named the Ogaki and HIJ-CREATE studies. In the Ogaki study, the risk reduction rate by candesartan was 52%. However, stents used in the study were only BMS after surviving restenosis. The risk reduction of the present study will be lower because of the higher onset rate of stent thrombosis in regard to DES. Furthermore, the risk reduction rate of candesartan for Japanese was 11% reported in HIJ-CREATE. The ACE-I usage rate was almost 70% in the control subjects of HIJ-CREATE. In the present study, ACE-I will be administered less frequently as low as 30%. Therefore, assumed risk reduction rate by candesartan in the present study could be higher. Considering all the various factors together, a reasonable risk reduction rate could be 25%.

Interventional
Phase 4
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Prevention
  • Hypertension
  • Coronary Artery Disease
Drug: Candesartan
Candesartan Cilexetil (4-12 mg per day)
Other Names:
  • Blopress
  • 4C
  • Active Comparator: Candesratan
    Intervention: Drug: Candesartan
  • No Intervention: Non-candesartan
Kondo J, Sone T, Tsuboi H, Mukawa H, Morishima I, Uesugi M, Kono T, Kosaka T, Yoshida T, Numaguchi Y, Matsui H, Murohara T, Okumura K. Effects of low-dose angiotensin II receptor blocker candesartan on cardiovascular events in patients with coronary artery disease. Am Heart J. 2003 Dec;146(6):E20.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
1119
April 2012
April 2009   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • A. Patients with hypertension, systolic blood pressure (SBP) = or > 140 and/or diastolic blood pressure (DBP) = or > 90
  • B. Patients with symptomatic heart failure lasting at least for 4 weeks (NYHA class = or > II), or those need continuous use of diuretics
  • C. Patients underwent coronary angioplasty with drug-eluting stents

Eligible patients are those who meet (A or B) and C.

Exclusion Criteria:

  • Severe renal or hepatic disease
  • Candidates for coronary artery bypass grafting (CABG)
  • Within 3 months after CABG
  • Allergic history to candesartan
  • Pregnant women
Both
Not Provided
No
Contact information is only displayed when the study is recruiting subjects
Japan
 
NCT00139386
CVM-RCT-2005-01
Yes
Hisao Ogawa, Kumamoto University
Kumamoto University
  • The 4C trial bureau
  • Japan Heart Foundation
Study Chair: Hisao Ogawa, MD, PhD Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
Kumamoto University
April 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP