Trial of Drug Eluting Stent Versus Bare Metal Stent to Treat Coronary Artery Stenosis (NORSTENT)

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborators:
The Research Council of Norway
The Royal Norwegian Ministry of Health
Norwegian Council on Cardiovascular diseases
Information provided by (Responsible Party):
University of Tromso
ClinicalTrials.gov Identifier:
NCT00811772
First received: December 18, 2008
Last updated: June 28, 2013
Last verified: January 2009
  Purpose

Stenosis of the coronary arteries may be treated by balloon dilatation followed by the implantation of a metal stent. However, restenosis occurs in 10-20% of patients treated with bare metal stents (BMS). Restenosis and treatment of restenosis is associated with risk of myocardial infarction (MI) and death. Drug eluting stents (DES)release drugs to the vessel wall that delay or inhibit the process of restenosis. Some reports have found that DES are associated with risk of acute stent thrombosis, MI and death. The precise magnitude of this risk is not known. Current evidence is therefore insufficient to balance the long-term risk and benefit of BMS vs DES.

The purpose of this trial is to compare the long-term effects on MI and total mortality of BMS vs DES. The trial will recruit 8000 patients from 8 Norwegian hospitals. The patients will be randomized to treatment with BMS or DES. Clinical events will be registered for 5 years after treatment. The study hypothesis is that there is no difference in the risk of death or myocardial infarction after treatment with BMS vs DES. The trial is initiated and run by university researchers and is sponsored by not-for-profit organizations.


Condition Intervention Phase
Coronary Atherosclerosis
Angina Pectoris
Myocardial Infarction
Device: Percutaneous coronary intervention (PCI)
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Comparison of the Long-term Effects on Mortality and Cardiovascular Morbidity of Percutaneous Coronary Intervention With Drug-eluting Stent Versus Bare-metal Stent. Randomized, Five-year Prospective, Multicenter Clinical Trial

Resource links provided by NLM:


Further study details as provided by University of Tromso:

Primary Outcome Measures:
  • First occurrence of all-cause mortality and non-fatal myocardial infarction (composite) [ Time Frame: After five years of follow-up ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Major cardiovascular events [ Time Frame: After five years of follow-up ] [ Designated as safety issue: Yes ]
  • Health related quality of life [ Time Frame: After 6 months and then yearly for 5 years ] [ Designated as safety issue: No ]

Estimated Enrollment: 9000
Study Start Date: September 2008
Estimated Study Completion Date: June 2015
Estimated Primary Completion Date: October 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Bare metal stent
Implantation of one or more bare metal stent(s) to to treat coronary artery stenosis
Device: Percutaneous coronary intervention (PCI)
Implantation of one or more bare metal stent(s)
Experimental: Drug eluting stent
Implantation of one or more drug eluting stent(s) to treat coronary artery stenosis
Device: Percutaneous coronary intervention (PCI)
Implantation of one or more drug eluting stent(s)

  Hide Detailed Description

Detailed Description:

Background:

The balance of the long-term risks and benefits of coronary drug-eluting stents versus bare metal stents is not known.

Study objective:

The primary objective of the trial is to compare in a real-world setting the long-term effects on the incidence of death and myocardial infarction (composite primary end-point) after implantation of drug-eluting stents versus bare-metal stents. The secondary objective is to compare the long-term effects on the incidence of total death, cardiovascular deaths, major cardiovascular events, angina pectoris, revascularization procedures, and on health-related quality of life after implantation of drug-eluting stents versus bare-metal stents. The main tertiary objective is to assess the safety and efficacy in patient subgroups with specific demographic, clinical, and vessel- or lesion characteristics, and to conduct a cost-effectiveness analysis.

Study design:

This is a randomized, five-year prospective, multicenter, open-label clinical trial with blinded end point-evaluation.

Setting:

Investigator initiated trial conducted at 8 Norwegian interventional centres. The trial is sponsored by the Norwegian Research Council, the Regional Health Authorities and other not-for-profit organizations.

Randomization:

Patients will be randomized to receive either drug-eluting stent(s) or a bare-metal stent(s) in a 1:1 ratio.

Patients:

The trial will include 9000 patients with de novo lesions in native coronary arteries or by-pass grafts who meet the eligibility criteria. Men and women with stable angina pectoris or acute coronary syndrome will be included.

End-point:

The primary composite end point is total death and nonfatal myocardial infarction.Secondary end-points include total death and subcategories of death, fatal and nonfatal myocardial infarction, fatal and nonfatal stroke, angina pectoris, revascularization, major bleeding, health-related quality of life.

Length of follow-up:

Five years.

End-points collected by electronic linkage to national registries:

The trial will use the unique Norwegian 11-digit person number to search the National Patient Registry and the National Death Registry for nonfatal and fatal end-points during follow-up, thereby minimizing loss to follow-up. Information on angina pectoris and health-related quality of life will be collected by questionnaires.

Statistical power:

The trial has a statistical power of 93 percent to detect a three percent (RR 1.176) absolute difference in incidence between the study groups, and a power of 64 percent to detect a two percent (RR 1.118) absolute difference, given a two-sided alpha value of 0.05.

Statistical analysis:

Statistical analyses will be conducted according to the intention-to-treat principle, and will be performed by using widely accepted statistical and/or graphical software.

Data collection:

Electronic Case Record Form (e-CRF)

Clinical Event Committee:

Adjudication of all end-points according to pre-specified and standardized criteria by Clinical Event Committee blinded to study assignment.

Expected Timelines:

First patient enrollment: September 2008 Last patient enrollment: February 2011 Completion of Follow-up: December 2014.

  Eligibility

Ages Eligible for Study:   19 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Men and women >18 years with stable angina pectoris or acute coronary syndrome
  • The patient has consented to participate and has signed the patient informed consent form
  • All lesions requiring intervention in one or more native coronary artery/coronary artery by-pass graft are amendable for implantation of drug-eluting stents only, or bare-metal stents only.
  • The patient has a unique 11-digit Norwegian person number, is able to communicate in Norwegian, and is expected not to emigrate during study follow-up.

Exclusion Criteria:

  • Previous implantation of a coronary bare metal stent or coronary drug eluting stent
  • Planned intervention of a bifurcation lesion with overlapping 2-stent technique
  • The patient has a serious medical condition (other than coronary artery disease) with a life expectancy less than 5 years
  • The patient is currently participating in another randomized trial that clinically interferes with the present trial, or requires coronary angiography or other coronary artery imaging procedures
  • Hypersensitivity or allergies to drugs or components in use with percutaneous coronary intervention
  • Contraindications for treatment with clopidogrel/ticlid for 9-12 months
  • Patient is receiving chronic anticoagulation therapy (e.g., warfarin, heparin)
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00811772

Locations
Norway
Department of Medicine, Sørlandet sykehus Arendal
Arendal, Norway, N-4838
Department of Heart Disease, Haukeland University Hospital
Bergen, Norway, N-5053 Bergen
Department of Heart Disease, Feiringklinikken AS
Feiring, Norway, N-2093
Department of Heart and Vascular Radiology and Department of Heart Disease, Ullevål University Hospital
Oslo, Norway, N-0450
Department of Heart Disease, Rikshospitalet HF
Oslo, Norway, N-0027
Department of Heart Disease, Stavanger University Hospital
Stavanger, Norway, N-4068
Department of Heart Disease, University Hospital of Northern Norway
Tromsø, Norway, N-9038
Department of Heart Disease, St.Olav University Hospital
Trondheim, Norway, N-7006
Sponsors and Collaborators
University of Tromso
The Research Council of Norway
The Royal Norwegian Ministry of Health
Norwegian Council on Cardiovascular diseases
Investigators
Principal Investigator: Kaare H Bønaa, MD, PhD Dept of Heart Disease, St.Olavs University Hospital, Trondheim, Norway; Norwegian University of Science and Technology, Trondheim, Norway; University of Tromsø, Tromsø, Norway
Study Chair: Jan E Nordrehaug, MD, PhD Department of Heart Disease, Haukeland University Hospital, Bergen, and University of Bergen, Bergen, Norway
  More Information

No publications provided

Responsible Party: University of Tromso
ClinicalTrials.gov Identifier: NCT00811772     History of Changes
Other Study ID Numbers: 184916/V50 Res. council Norway, NSD19480, PREKNORD40/2008
Study First Received: December 18, 2008
Last Updated: June 28, 2013
Health Authority: Norway:National Committee for Medical and Health Research Ethics
Norway: Norwegian Social Science Data Services

Keywords provided by University of Tromso:
Randomized controlled trial
Bare metal stent
Drug eluting stent

Additional relevant MeSH terms:
Angina Pectoris
Atherosclerosis
Coronary Artery Disease
Myocardial Ischemia
Infarction
Myocardial Infarction
Coronary Stenosis
Heart Diseases
Cardiovascular Diseases
Vascular Diseases
Chest Pain
Pain
Signs and Symptoms
Arteriosclerosis
Arterial Occlusive Diseases
Coronary Disease
Ischemia
Pathologic Processes
Necrosis

ClinicalTrials.gov processed this record on July 23, 2014