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Comparison of Two Treatment Strategies in Patients With an Acute Coronary Syndrome Without ST Elevation (SISCA)

This study has been terminated.
(Because of inclusion delay)
Information provided by (Responsible Party):
FREDERIC LAPOSTOLLE, Hospital Avicenne Identifier:
First received: March 7, 2007
Last updated: February 9, 2015
Last verified: February 2015

The acute coronary syndrome (ACS) without ST elevation is a frequent pathology. The main evolutionary risk of these patients is the coronary thrombosis and its self complications. The platelets aggregation plays a major role in the physiopathology of the ACS. The therapeutic arsenal of the anti-thrombosis essentially resting on aspirin and heparin has been reinforced lately by the inhibitors of the glycoprotein anti GP IIb/IIIa. The profit of these products in the ACS with or without ST elevation, associated or not to coronarography, has clearly been demonstrated. This profit is more marked when patients are at high risk of complications. Thus, the use of an anti GP IIb/IIIa is recommended among patients at "high risk" for whom a coronarography is planned, in the last international recommendations of the European Cardiology Society (ESC), the American Heart Association and the American College of Chest Physician. Otherwise, some authors have proposed An early invasive strategy based on coronarography with discordant results. The ideal delay of realization of this coronarography is unknown. It varies according to the studies between 2.5 hours to 48 hours. Once again, patients at high risk seem to benefit the more of such a strategy if it is set precociously.

Objective To compare an invasive strategy associating an early administration of tirofiban and a coronarography achieved in the 6 hours after the randomization to a conservative strategy in a population of high risk patients with ACS without ST elevation.

Design Multicentric, prospective, randomized study.

Condition Intervention Phase
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Treatment by Anti GP IIb/IIIa in the Setting of a Strategy of Early Coronarography to Patients With an Acute Coronary Syndrome Without ST Elevation

Resource links provided by NLM:

Further study details as provided by Hospital Avicenne:

Primary Outcome Measures:
  • Mortality, Myocardial Infarction and Revascularization in Emergency [ Time Frame: d30 ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Therapeutic Failure (Well Defined) During the First 6 Hours. Clinical Evolution and Electrocardiography [ Time Frame: until the exit from the hospital and at d30. ] [ Designated as safety issue: No ]
  • Coronarographic Criteria : TIMI Score at the Beginning and the End of the Procedure; Existence of an Intra-coronary Thrombus [ Time Frame: d30 ] [ Designated as safety issue: No ]
  • Troponin Peak. Left Ventricular Ejection Fraction Before Hospital Exit. Length of Stay in USIC and Hospital. Hemorrhagic Complications. [ Time Frame: d30 ] [ Designated as safety issue: No ]

Enrollment: 170
Study Start Date: March 2007
Study Completion Date: July 2013
Primary Completion Date: December 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Early Invasive strategy
Tirofiban and coronarography within 6 hours
intravenous infusion
Other Name: IIb/IIIa GP inhibitor
standard procedure of coronarography
Other Name: angiography
Active Comparator: Delayed invasive strategy
Coronarography after 6 hours
standard procedure of coronarography
Other Name: angiography

Detailed Description:

Patient's selection Patient of more than 18 years with a ACS defined by a thoracic pain of more than 20 minutes that occurred during the last 24 hours, anomalies on EKG and one of the following criteria : diabetes; recurrence of coronary pain; precocious pain post-myocardial infarction; falling of the ST segment of > 1 mm; transient elevation of the ST segment > 1 mm; elevation of the I troponin, T troponin or CPK MB; hemodynamic instability; ventricular arrhythmia; TIMI score > 5

Therapeutic modes All patients receive : aspirin, clopidogrel, enoxaparine. Trinitrin and analgesics are at the clinician's appreciation. Besides, either they receive an anti GP IIb/IIIa: tirofiban (Agrastat®) and are oriented in cardiology to have a coronarography in the six hours or they are oriented in cardiology to receive the classical treatment, guided by the investigations searching for signs of myocardial ischemia.


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • High risk ACS without ST elevation

Exclusion Criteria:

  • Age <18 years
  • Pregnancy
  • Persistence of the ST elevation
  • Recent left branch block
  • Cardiac failure or cardiogenic shock (Kilip 3 or 4)
  • Treatment by anti-vitamin K
  • Contra-indication to the use of one of the following treatments: aspirin, clopidogrel, enoxaparine, anti GP IIb/IIIa (tirofiban)
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Please refer to this study by its identifier: NCT00445263

Samu 93 - Chu Avicenne
Bobigny, Ile de France, France, 93000
Sponsors and Collaborators
Hospital Avicenne
  More Information

Responsible Party: FREDERIC LAPOSTOLLE, Frédéric Lapostolle, Hospital Avicenne Identifier: NCT00445263     History of Changes
Other Study ID Numbers: PC/AP 39-2005 
Study First Received: March 7, 2007
Results First Received: January 26, 2015
Last Updated: February 9, 2015
Health Authority: France: Institutional Ethical Committee

Keywords provided by Hospital Avicenne:

Additional relevant MeSH terms:
Acute Coronary Syndrome
Coronary Disease
Coronary Artery Disease
Myocardial Ischemia
Heart Diseases
Cardiovascular Diseases
Vascular Diseases
Arterial Occlusive Diseases
Fibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action
Platelet Aggregation Inhibitors processed this record on October 21, 2016