The Safety of Transdermal Nicotine Immediately Following an Acute Coronary Syndrome (STADIA)

This study has suspended participant recruitment.
(Difficulties with enrollment.)
Sponsor:
Collaborator:
Canadian Tobacco Control Research Initiative
Information provided by:
Sir Mortimer B. Davis - Jewish General Hospital
ClinicalTrials.gov Identifier:
NCT00990197
First received: October 5, 2009
Last updated: NA
Last verified: October 2009
History: No changes posted
  Purpose

Continuing to smoke after having a heart attack greatly increases the risk of death and cardiac illness. The nicotine patch is a commonly used pharmacotherapy for smoking cessation and has great potential to help heart attack patients quit smoking. However, due to safety concerns, physicians are often hesitant to prescribe the nicotine patch to patients who have just suffered a heart attack. The STADIA pilot study will assess the feasibility of a large-scale clinical trial investigating safety and efficacy outcomes associated with the nicotine patch immediately following a heart attack. Eligible subjects will be randomized within 48 hours of suffering a heart attack to wear a transdermal nicotine patch on either day 1 or day 2 of the study period. The nicotine patch will deliver nicotine to the patient over the period of 24 hours. Patients will be advised to discuss smoking cessation strategies with their treating physician and subsequent care will be left to the discretion of this physician. The duration of ischemia (loss of blood flow in the heart), patient adherence, incidence of arrhythmia (disorder of the heart rate or rhythm), heart rate, and blood pressure within the two groups will be used to evaluate the safety of transdermal nicotine use immediately after a heart attack.


Condition Intervention
Smoking Cessation
Drug: Transdermal nicotine patch

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Crossover Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: The Safety of Transdermal Nicotine Immediately Following an Acute Coronary Syndrome: The STADIA Pilot Study

Resource links provided by NLM:


Further study details as provided by Sir Mortimer B. Davis - Jewish General Hospital:

Primary Outcome Measures:
  • The total duration of ischemic episodes [ Time Frame: Day 1 and Day 2 ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Patient adherence to study protocol [ Time Frame: Day 1, Day 7, Day 14 ] [ Designated as safety issue: No ]
  • Incidence of arrhythmia [ Time Frame: Day 1 and Day 2 ] [ Designated as safety issue: Yes ]
  • Heart rate [ Time Frame: Day 1 and Day 2 ] [ Designated as safety issue: Yes ]
  • Systolic and diastolic blood pressure [ Time Frame: Day 1 and Day 2 ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 30
Study Start Date: June 2005
Estimated Study Completion Date: December 2009
Estimated Primary Completion Date: July 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Day 1
Patients randomized to wearing the patch on day 1 will apply a patch on the morning of their treatment day and keep it on for 24 hours. These patients will not wear a patch on day 2.
Drug: Transdermal nicotine patch
Subjects will apply the nicotine patch on the morning of their treatment day and will keep it on for 24 hours.
Other Name: Nicoderm CQ, Biovail Pharmaceuticals
Active Comparator: Day 2
Patients randomized to wearing the patch on day 2 will apply a patch on the morning of their treatment day and keep it on for 24 hours. These patients will not wear a patch on day 1.
Drug: Transdermal nicotine patch
Subjects will apply the nicotine patch on the morning of their treatment day and will keep it on for 24 hours.
Other Name: Nicoderm CQ, Biovail Pharmaceuticals

  Hide Detailed Description

Detailed Description:

Objective

The STADIA Pilot Study will be used to evaluate the feasibility of conducting a three-year multi-centre trial investigating the long-term safety and efficacy outcomes associated with transdermal nicotine use immediately following an acute coronary syndrome (ACS).

Rationale

Patients who initially survive an ACS are at high risk of recurrent cardiac events or cardiovascular death. Within the first 6 months alone, 12% of patients will die or suffer another ACS, while another 23% will require revascularization for angina. Patients who are able to quit smoking reduce their chances of suffering a recurrent ACS or cardiovascular death within the next year by ≥ 50%. After surviving an ACS, most patients are highly motivated to stop smoking. However, as nicotine is an extremely addictive psychoactive drug, up to 60% of patients who attempt to quit relapse. Hospitalization following an ACS provides an opportunity for smokers to quit, as smoking while in hospital is prohibited. However, abstinence while hospitalized also precipitates intense nicotine withdrawal symptoms, which are largely responsible for the high rates of smoking relapse. Nicotine replacement therapy (NRT) can ameliorate many of these symptoms and increase the chances that smokers continue to abstain from tobacco use after discharge. Of the available NRTs, transdermal nicotine is associated with the least severe cardiovascular effects, as it delivers nicotine more gradually (with lower peak values) than nicotine gum or inhalers. Although transdermal nicotine more than doubles long-term smoking cessation rates when compared with placebo, it is rarely prescribed by physicians in the weeks immediately following an ACS because the possible cardiovascular effects of nicotine after an ACS have yet to be systematically evaluated.

Methods

A total of 30 patients will be randomized within 48-hours of suffering an ACS from the Jewish General Hospital (Montreal, QC) and collaborating centres. Prior to randomization, all patients will receive standardized smoking cessation counselling. Subjects who satisfy the inclusion and exclusion criteria for the trial will be randomized within 48 hours of suffering an ACS to wear a transdermal nicotine patch on either day 1 or day 2 of the study period. Subjects will apply a patch the morning of their treatment day and keep it on for 24 hours. Patients will be advised to discuss smoking cessation strategies with their treating physician and subsequent care will be left to the discretion of this physician. Twenty-four hour Holter monitoring will be used to measure heart rate, incidence of arrhythmia, and the duration of ischemic events at day 1 and day 2 of the study period. Systolic and diastolic blood pressure will be assessed via 24-hour Ambulatory blood pressure monitoring (ABPM). ABPM will be used on day 1 and day 2 of the study period. On day 1 the study nurse will record the severity of nicotine withdrawal symptoms, side effects, any smoking relapses and if so, how many cigarettes were smoked, and any medications they are currently taking. On day 7 and 14 patients will be contacted by telephone to determine the severity of nicotine withdrawal symptoms, any smoking relapses and if so, how many cigarettes were smoked and any medications they are currently taking. Cardiovascular events will be assessed by patient monitoring and by a study nurse. Nicotine withdrawal symptoms according to the Hughes-Hatsukami symptom scale and common nicotine patch side effects, severity-rated on a five-point scale, will be determined through study nurse inquiries on days 1, 7, and 14 (6). Carbon monoxide monitors will be used to measure levels of expired CO at baseline. Participants whose levels of expired CO exceed 10 ppm will be classified as smokers.

Significance

If shown to be safe and effective, transdermal nicotine will have a major impact on the secondary prevention of recurrent cardiac events on the 20,000 Canadian smokers who suffer an ACS each year.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age ≥ 18 years
  • Current smoker, ≥ 10 cigarettes per day, on average, for the past year
  • Suffered an enzyme-positive ACS (Troponin T, Troponin I, or CK-MD) and planned hospitalization of ≥ 48 hours
  • Motivated to quit smoking

Exclusion Criteria:

  • Current use of any medical therapy for smoking cessation
  • History of alcohol or controlled substance abuse
  • History of severe dermatitis
  • Current diagnosis of unstable psychiatric illness requiring medication
  • Suffered an ACS as a complication of a hospitalization for a different condition (i.e. postoperatively)
  • Pregnancy or lactation
  • Likely to be unavailable for follow-up
  • Unable to read and understand English or French
  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: NCT00990197

Locations
Canada, Quebec
SMDB Jewish General Hospital
Montreal, Quebec, Canada, H3T 1E2
Sponsors and Collaborators
Sir Mortimer B. Davis - Jewish General Hospital
Canadian Tobacco Control Research Initiative
Investigators
Principal Investigator: Mark J Eisenberg, MD MPH Jewish General Hospital/McGill University
  More Information

Publications:
Kaijser L, Berglund B. Effect of nicotine on coronary blood-flow n man. Clinical Physiology 2004; 5:541-552.
Hwang SL WM. Heart attacks reported in patch users still smoking. Wall Street Journal 1992;(June 19):B1.
Hughes JR, Glaser M. Transdermal nicotine for smoking cessation. Health Values 1993; 17(2):25-31.
Moyer D. Chapter 13: Physical fitness and carbon monoxide. Tobacco Reference Guide 2000;30-34.

Responsible Party: Mark J. Eisenberg, MD MPH, Jewish General Hospital/McGill University
ClinicalTrials.gov Identifier: NCT00990197     History of Changes
Other Study ID Numbers: 05-023, 016026
Study First Received: October 5, 2009
Last Updated: October 5, 2009
Health Authority: Canada: Canadian Institutes of Health Research
Canada: Ethics Review Committee

Keywords provided by Sir Mortimer B. Davis - Jewish General Hospital:
Pilot study
Randomized clinical trial
Smoking cessation
Acute coronary syndrome
Transdermal nicotine patch

Additional relevant MeSH terms:
Acute Coronary Syndrome
Syndrome
Angina Pectoris
Cardiovascular Diseases
Chest Pain
Disease
Heart Diseases
Myocardial Ischemia
Pain
Pathologic Processes
Signs and Symptoms
Vascular Diseases
Nicotine
Autonomic Agents
Cholinergic Agents
Cholinergic Agonists
Ganglionic Stimulants
Molecular Mechanisms of Pharmacological Action
Neurotransmitter Agents
Nicotinic Agonists
Peripheral Nervous System Agents
Pharmacologic Actions
Physiological Effects of Drugs

ClinicalTrials.gov processed this record on October 23, 2014