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INSTANT: INtegrilin Plus STenting to Avoid Myocardial Necrosis Trial (INSTANT)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT00638976
Recruitment Status : Completed
First Posted : March 19, 2008
Last Update Posted : May 28, 2010
Sponsor:
Information provided by:

Study Description
Brief Summary:
Randomized, blind controlled, Multicenter, spontaneous, prospective trial, roughly 20 enrolling centers in Italy, placebo and active drug supply given by GlaxoSmithKline (GSK).

Condition or disease Intervention/treatment Phase
Cardiovascular Disease Drug: eptifibatide Drug: placebo Phase 3

Detailed Description:
The Objective of the trial is compare the efficacy and, secondarily, the safety and effectiveness of pre-procedural use of the Gp IIb/IIIa inhibitor eptifibatide in comparison to placebo in patients with diffuse CAD undergoing multiple DES implantation.

Study Design

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 91 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Supportive Care
Official Title: INSTANT: INtegrilin Plus STenting to Avoid Myocardial Necrosis Trial
Study Start Date : November 2007
Primary Completion Date : February 2010
Study Completion Date : May 2010

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Arms and Interventions

Arm Intervention/treatment
1.Integrilin, GSK
Pre-procedural use of the Gp IIb/IIIa inhibitor eptifibatide (Integrilin, GSK) vs matched placebo.
Drug: eptifibatide
Enrolled patients will be randomized in the catheterization laboratory, after the decision to perform PCI by means of planned implantation of DES >33 mm in length in the same coronary vessel, to IV placebo or IV eptifibatide (double bolus [180 microg/kg] followed by infusion [2 microg/kg per minute] for 18 to 24 hours after the procedure
Placebo Comparator: 2
Pre-procedural use of the Gp IIb/IIIa inhibitor eptifibatide (Integrilin, GSK) vs matched placebo.
Drug: placebo
Enrolled patients will be randomized in the catheterization laboratory, after the decision to perform PCI by means of planned implantation of DES >33 mm in length in the same coronary vessel, to IV placebo or IV eptifibatide (double bolus [180 microg/kg] followed by infusion [2 microg/kg per minute] for 18 to 24 hours after the procedure


Outcome Measures

Eligibility Criteria

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Candidates for this study must meet all of the following criteria:

  • Male or female able to understand and sign a witnessed informed consent
  • Age ≥ 18 yo
  • Patients with stable (CCS 1-4) or unstable angina pectoris (but with the most recent anginal episode occurring >48 hours before the procedure) or documented silent ischemia
  • Stable Hemodynamic conditions (systolic BP > 100 HR > 40 < 100).
  • No clinical and ECG changes suggestive of ongoing acute or recent (<48 hours) myocardial infarction.
  • Angiographic evidence of a de novo lesion > 50% requiring implantation of two DES in overlapping with a total stent length > 33 mm and reference vessel diameter between 2.5 and 4.0 mm (by visual estimation) in one coronary vessel. Multiple lesions in the same vessels can be included but at least one lesion should require implantation of two DES in overlapping with a total stent length > 33 mm. The definition of multivessel disease requires an intention to treat at least two lesions (with a least one with the characteristics reported above) in two different major epicardial segments. For example, the presence of a lesion in the left anterior descending artery and in the obtuse marginal or the presence of a lesions in the right postero-lateral branch and in a diagonal branch will qualify as multivessel. The presence of lesions in the left anterior descending artery and in the diagonal branch will not qualify as multivessel. Bifurcation lesions and ostial lesions can be included, but only if at least two DES in overlapping with a total stent length > 33 mm are implanted in the same branch. When treating diffuse lesion in the same vessel, overlapping stenting is recommended with high pressure (>14 atm post-dilation) of the overlap zone. There is no maximum stent length to treat one coronary vessel.

Exclusion Criteria:

  • Female sex with childbearing potential
  • Age <18 years
  • Ongoing or recent episode (<48 hours) of unstable coronary artery disease (including both ST-elevation and non-ST-elevation acute coronary syndromes)
  • Administration of any GP IIb/IIIa inhibitors during the previous 2 weeks
  • Serum creatinine >2.5 mg/dl or with a creatinine clearance <40mL/min
  • Ongoing serious bleeding or bleeding diathesis
  • Previous stroke in the last 6 months
  • Major surgery within the previous 6 weeks
  • Platelet count <100,000 per mm3
  • Ejection Fraction below 30%
  • The patient has a known hypersensitivity or contraindication to aspirin, heparin, clopidogrel, or sensitivity to contrast which cannot be adequately pre-medicated.
  • Hemodynamic instability (systolic blood pressure < 100 mm Hg; heart rate < 40 bpm or >100 bpm; complex ventricular arrhythmias; AV block) requiring balloon counterpulsation or inotropic support.
  • The patient is simultaneously participating in another device or drug study. Patient must have completed the follow-up phase of any previous study at least 30 days prior to enrolment in this study.
  • Positive clinical history for intracranial neoplasia, AV malformation, aneurysm.
  • INR ≥ 2.0 or prothrombin time 1.2 times upper limit of normality
  • Clinically manifested reduced liver function
  • Programmed surgery within six months

Angiographic Exclusion Criteria:

  • DES implantation in a chronic total occlusion or for the treatment of in-stent restenosis.
  • Treatment of lesions where the operator feels necessary the usage of rotactional atherectomy
  • Vessel size < 2.25 mm or > 5 mm (by visual estimation).
  • Previous implantation of a bare/DES in the target lesion
Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00638976


Locations
Italy
Mediolanum Cardio Research
Milan, Italy, 20144
Sponsors and Collaborators
Fondazione Evidence per Attività e Ricerche Cardiovascolari ONLUS
More Information

Responsible Party: Principal Investigator: Dr. Giuseppe Massimo Sangiorgi, PTV Rome
ClinicalTrials.gov Identifier: NCT00638976     History of Changes
Other Study ID Numbers: Fondazione Mediolanum 001/2007
First Posted: March 19, 2008    Key Record Dates
Last Update Posted: May 28, 2010
Last Verified: May 2010

Keywords provided by Fondazione Evidence per Attività e Ricerche Cardiovascolari ONLUS:
Eptifibatide
IV eptifibatide
GP IIB/IIIA inhibitors
DES stent

Additional relevant MeSH terms:
Cardiovascular Diseases
Necrosis
Myocardial Infarction
Pathologic Processes
Myocardial Ischemia
Heart Diseases
Vascular Diseases
Eptifibatide
Platelet Aggregation Inhibitors