Remote Postconditioning in Patients With Acute Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention (PCI) (RemPostCon)

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Maurizio Ferrario, IRCCS Policlinico S. Matteo
ClinicalTrials.gov Identifier:
NCT00865722
First received: March 18, 2009
Last updated: August 16, 2012
Last verified: August 2012
  Purpose

Background: Experimental studies suggest that remote limb ischaemic postconditioning (RemPostCon) can reduce infarct size in pigs. Initial clinical applications support the beneficial role of RemPostCon in preserving endothelial function during upper limb ischemia in healthy volunteers and in patients with stable coronary artery disease.

Aim of the study: To evaluate the feasibility, safety and efficacy of RemPostCon in the setting of STEMI and primary PCI (pPCI) and to investigate potential circulating mediators of its effects.

Patients and methods: Patients who undergo pPCI for anterior STEMI within 6 hours since the onset of symptoms are randomly assigned to receive either RemPostCon + pPCI or pPCI alone in a single-blind fashion. All patients receive therapy according to the current international guidelines. Three cycles of ischemia-reperfusion are provided to the lower limb inflating a cuff to 200 mmHg. Each cycle consists of 5' of ischaemia, followed by 5' of reperfusion. RemPostCon is started at the time of angioplasty in the infarct related artery. Primary endpoint is the area under the curve (AUC) of creatinine kinase - MB (CK - MB). Cardiac magnetic resonance (CMR) is performed early before discharge and 4 months after the event, if there are no contraindications.


Condition Intervention Phase
Myocardial Reperfusion Injury
Myocardial Ischemia
Myocardial Infarction
Procedure: Remote Postconditioning
Phase 2
Phase 3

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: Pilot Study to Test Feasibility, Safety, Molecular Mediators and Preliminary Efficacy of Remote Myocardial Postconditioning Provided With Extrinsic Cuff Compression of Lower Limb During Primary PCI

Resource links provided by NLM:


Further study details as provided by IRCCS Policlinico S. Matteo:

Primary Outcome Measures:
  • Area Under the Curve of CK - MB release [ Time Frame: baseline to 72h since admission ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Area Under the Curve of CK release [ Time Frame: baselinte to 72h since admission ] [ Designated as safety issue: No ]
  • TIMI Frame Count [ Time Frame: 30 minutes after first balloon inflation in infarct-related artery ] [ Designated as safety issue: No ]
  • Time to balloon [ Time Frame: during pPCI ] [ Designated as safety issue: Yes ]
  • Ejection Fraction MRI [ Time Frame: before discharge and after 4 months ] [ Designated as safety issue: No ]
  • Myocardial Blush grading [ Time Frame: 30 minutes after first balloon inflation ] [ Designated as safety issue: No ]
  • ST segment resolution [ Time Frame: 6h after balloon ] [ Designated as safety issue: No ]
  • Troponin I peak [ Time Frame: 72h since admission ] [ Designated as safety issue: No ]
  • Mortality rate [ Time Frame: 4 months since admission ] [ Designated as safety issue: Yes ]
  • artero-venous differences in pO2, pCO2, pH, HCo3 [ Time Frame: baseline and 30 minutes after first balloon inflation ] [ Designated as safety issue: No ]
  • Major adverse cardiac events [ Time Frame: 4 months since admission ] [ Designated as safety issue: Yes ]
  • artero-venous quantitative and qualitative differences in endothelial progenitors cells (subgroups) [ Time Frame: within 24 h since admission ] [ Designated as safety issue: No ]
  • artero-venous Differences of Cytokines [ Time Frame: within 24h since admission ] [ Designated as safety issue: No ]
  • Edema Volume T2 sequences MRI [ Time Frame: before discharge ] [ Designated as safety issue: No ]
  • Delay enhancement volume MRI [ Time Frame: before discharge and after 4 months ] [ Designated as safety issue: No ]

Estimated Enrollment: 96
Study Start Date: March 2009
Study Completion Date: May 2012
Primary Completion Date: May 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: RemotePostConditioning
Patients will receive pPCI and treatments according to guidelines for STEMI PLUS extrinsic cuff compression to the lower limb for 5 ' followed by 5' reperfusion for three cycles (30' in total) starting with myocardial reperfusion
Procedure: Remote Postconditioning
Lower limb compression using a cuff inflated to 200 mmHg for 5 ' followed by 5' of reperfusion fo three times during 30'
Sham Comparator: Controls
pPCI and treatments according to guidelines for STEMI
Procedure: Remote Postconditioning
Lower limb compression using a cuff inflated to 200 mmHg for 5 ' followed by 5' of reperfusion fo three times during 30'

  Eligibility

Ages Eligible for Study:   18 Years to 80 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age >= 18 yrs AND Age =< 80 yrs
  • STEMI definition
  • Pain to door time < 6 hrs
  • Killip class 1 - 2 - 3
  • Initial TIMI flow 0 - 1 in the anterior descending artery
  • Signed informed consent

Exclusion Criteria:

  • Pregnancy
  • Cardiogenic shock
  • Initial TIMI flow 2 - 3 in the anterior descending artery
  • History of prior MI in the past 6 months
  • History of prior CABG
  • History of peripheral vascular disease III - IV grade
  • History of abdominal Aortic Aneurysm > 5 cm
  • Severe coronaropathy that could condition further revascularization before the end of the study
  • Other relevant medical or surgical conditions that can influence prognosis at 4 months
  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: NCT00865722

Locations
Italy
ASL3 Genovese, Villa Scassi Hospitale
Genoa, Italy, 16100
IRCCS Policlinico San Matteo
Pavia, Italy, 27100
Sponsors and Collaborators
IRCCS Policlinico S. Matteo
Investigators
Study Director: Maurizio Ferrario, MD IRCCS Policlinico San Matteo
Principal Investigator: Gabriele Crimi, MD IRCCS Policlinico San Matteo
  More Information

No publications provided by IRCCS Policlinico S. Matteo

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Maurizio Ferrario, MD, IRCCS Policlinico S. Matteo
ClinicalTrials.gov Identifier: NCT00865722     History of Changes
Other Study ID Numbers: RemPostConditioning
Study First Received: March 18, 2009
Last Updated: August 16, 2012
Health Authority: Italy: National Monitoring Centre for Clinical Trials - Ministry of Health

Keywords provided by IRCCS Policlinico S. Matteo:
Remote Postconditioning
Myocardial reperfusion Injury
Myocardial Infarction
Primary PCI

Additional relevant MeSH terms:
Myocardial Ischemia
Coronary Artery Disease
Infarction
Ischemia
Myocardial Infarction
Myocardial Reperfusion Injury
Reperfusion Injury
Wounds and Injuries
Heart Diseases
Cardiovascular Diseases
Vascular Diseases
Coronary Disease
Arteriosclerosis
Arterial Occlusive Diseases
Pathologic Processes
Necrosis
Cardiomyopathies
Postoperative Complications

ClinicalTrials.gov processed this record on July 26, 2014