A Randomized Multicentre Trial to Evaluate the Utilization of Revascularization or Optimal Medical Therapy for the Treatment of Chronic Total Coronary Occlusions (EuroCTO)

This study is currently recruiting participants. (see Contacts and Locations)
Verified February 2015 by Euro CTO Club
NHS Research and Development
Biosensors International
Asahi Intecc Co., Ltd.
Information provided by (Responsible Party):
Euro CTO Club
ClinicalTrials.gov Identifier:
First received: January 1, 2013
Last updated: February 12, 2015
Last verified: February 2015

CTOs are common among patients with angina, and are detected in around 20% of patients undergoing coronary angiography. Treatment of CTO has been found to constitute only 7% of PCI practice on average. One of the reasons for the under-presentation of CTOs in PCI target lesions is the lack of evidence-based medical data on treatment indications, and the continued low level of accepted evidence for the treatment of CTOs by PCI in PCI guidelines.

Patients with a CTO represent patients with stable coronary artery disease. The COURAGE trial comparing PCI with optimal medical therapy in stable coronary disease did not show a difference in mortality or myocardial infarction between the two treatment options. However, CTOs were not included in the COURAGE trial. But that trial did confirm the superiority of PCI over OMT in controlling symptoms of angina, with a high cross-over rate to PCI. Whether PCI for CTO is superior to OMT in reducing MACE in those patients with a large ischaemic burden has never been tested in a randomized controlled trial.

While there is compelling evidence from registry studies of a clinical and prognostic benefit following successful PCI of CTO compared with PCI failure, there has been no randomized controlled trial of contemporary PCI using drug-eluting stents versus optimal medical therapy. The COURAGE trial nuclear sub-study confirms both that prognosis is closely related to the extent of residual ischaemia and that PCI is more effective in reducing residual ischaemia than optimal medical therapy alone. This confirms earlier retrospective data suggesting that the benefit of PCI is greatest in patients with moderate (10-20%) or severe (>20%) ischaemia.

Study hypothesis: PCI with Biolimus eluting stent implantation plus OMT will be superior to OMT alone in improving health status at 12-month follow-up, and will be noninferior with respect to the composite of all cause death/ non fatal MI at 36-month follow up, in patients with a CTO in an epicardial coronary artery >2.5 mm diameter and chronic stable angina with evidence of ischemia and viability in the territory subtended by the CTO

Condition Intervention
Chronic Stable Angina
Coronary Occlusion
Device: Biolimus-eluting stent implantation

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Randomized Multicentre Trial to Evaluate the Utilization of Revascularization or Optimal Medical Therapy for the Treatment of Chronic Total Coronary Occlusions

Resource links provided by NLM:

Further study details as provided by Euro CTO Club:

Primary Outcome Measures:
  • Quality of Life [ Time Frame: Baseline and 12 months ] [ Designated as safety issue: No ]
    Seattle Angina Questionnaire and EQ-5D for health outcomes measurement

  • Major cardiovascular events [ Time Frame: 36 months ] [ Designated as safety issue: Yes ]
    Cumulative composite endpoint of all-cause death, non-fatal MI at 3 years

Secondary Outcome Measures:
  • Safety and efficacy endpoints [ Time Frame: 12 and 36 months ] [ Designated as safety issue: Yes ]
    All cause mortality Cardiac mortality Myocardial Infarction Any hospitalization due to cardiovascular events (angina, congestive heart failure, arrythmias)

  • Prcedural complications [ Time Frame: baseline upto 36 months ] [ Designated as safety issue: Yes ]
    Incl. periprocedural enzyme leak (defined by CK increase >3 times ULN); pericprocedural MI (new Q-wave or STEMI); pericardial tamponade, need for urgent CABG, CIN, death within 30 days, proven periprocedural cerebrovascular events

  • Protocol adherence [ Time Frame: 36 months ] [ Designated as safety issue: Yes ]
    Need to cross from OMT to PCI in Group 2 (after escalation up to maximum tolerated anti-anginal therapy and persistent unequivocal symptoms)

  • Per protocol analysis [ Time Frame: 36 months ] [ Designated as safety issue: Yes ]
    primary endpoint comparison in patients who did have a successful revascularization compared to those patients treated medically who had no subsequent PCI

Other Outcome Measures:
  • Health-economic analysis [ Time Frame: 12 and 36 months ] [ Designated as safety issue: No ]
    Economic assessment & cost efficacy

Estimated Enrollment: 1200
Study Start Date: March 2012
Estimated Study Completion Date: June 2018
Estimated Primary Completion Date: June 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Biolimus-eluting stent implantation
PCI of CTO using a Biomatrix drug-eluting stent system + optimal medical therapy.
Device: Biolimus-eluting stent implantation
Recanalization of chronic coronary artery occlusion and subsequent implantation of one or ore Biosensor stents
Other Name: Biosensors Biolimus-eluting stents of all sizes and lengths
No Intervention: Medical therapy
Optimal medical therapy. Subsequent PCI only if symptoms of angina persist despite optimal medical therapy. At least 2 anti-anginal agents or the maximum tolerated anti-anginal therapy should be used before crossover. Medical therapy should include adequate ventricular rate-limiting medication (i.e. Beta-blocker or rate-limiting calcium antagonist) where appropriate.


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

Inclusion Criteria:

  • ≥ 18 years of age with written informed consent
  • CTO in native coronary artery
  • a) Stable angina, or b) myocardial ischaemia in a territory supplied by CTO, and c) viability in akinetic myocardium (<50% transmural late enhancement on MRI or normal resting perfusion scan)
  • CTO located in segments 1-3 (RCA), 6-7 (LAD), 11-12 (LCx)
  • target artery ≥2.5mm

Exclusion Criteria:

  • AMI or NSTE-ACS within 1 month
  • Significant untreated coronary stenosis in a territory other than CTO
  • Patients with MVD and significant non-CTO stenoses where it is deemed unsafe to treat the non-CTO lesion first (e.g. Significant proximal LAD lesion with chronically occluded RCA)
  • Patient unsuitable for 12 month dual anti-platelet therapy
  • Any exclusion criteria for PCI or DES
  • Pregnant or nursing patients and those who plan pregnancy in the period up to 1 year following index procedure
  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: NCT01760083

Clinique Saint-Augustin Recruiting
Bordeaux, France, 33074
Contact: Jean-Louis Leymarie, MD    33 (0)5 57 81 07 81      
Principal Investigator: Jean-Lois Leymarie, MD         
CH de Lagny Recruiting
Lagny, France, 77405
Contact: Simone Elhadad, MD    33 (0)1 64 30 76 22      
Principal Investigator: Simon Elhadad, MD         
Institut Hospitalier Jacques Cartier - ICPS Recruiting
Massy, France, 91300
Contact: Yves Louvard, MD    33 (0)1 60 13 61 68      
Principal Investigator: Yves Louvard, MD         
Clinique Pasteur Recruiting
Toulouse, France, 31076
Contact: Didier Tchetche, MD    33 (0)5 62 21 31 31      
Principal Investigator: Didier Tchetche, MD         
Rangueil university hospital Recruiting
Toulouse, France, 31076
Contact: Nicolas Boudou, MD    33 (0)5-61-32-26-65      
Principal Investigator: Nicolas Boudou, MD         
Zentralklinik Bad Berka Recruiting
Bad Berka, Germany, 99438
Contact: Bernward Lauer, MD    +49 (0)36458/5-1201      
Principal Investigator: Berward Lauer, MD         
Herz-Zentrum Bad Krozingen Recruiting
Bad Krozingen, Germany, 79189
Contact: Heinz-Joachim Büttner, MD    49 07633/402-0      
Principal Investigator: Heinz-Joachim Büttner, MD         
Main Taunus Kliniken Recruiting
Bad Soden, Germany, 65812
Contact: Nicolaus Reifart, MD PhD       n.reifart@reifart-partner.de   
Principal Investigator: Nicolaus Reifart, MD PhD         
Klinikum Darmstadt Recruiting
Darmstadt, Germany, 64283
Contact: Gerald S Werner, MD    4906151010706401      
Principal Investigator: Hiller Moehlis, MD         
Sub-Investigator: Gerald S Werner, MD         
Cardiac Catheterization Laboratory and Cardiovascular Interventional Unit Cannizzaro Hospita Completed
Catania, Italy, 95126
Latvian Center of Cardiology Pauls Stradins Clinical University Hospital Recruiting
Riga, Latvia, 1002
Contact: Andrejs A Erglis, MD PhD    +371 67 06 93 79      
Principal Investigator: Andrejs A Erglis, MD PhD         
Sub-Investigator: Aigars Lismanis, MD         
Unidad de Cardiología Intervencionista Hospital de Sant Pau Recruiting
Barcelona, Spain, 08025
Contact: Antonio Serra, MD    +34 935565851      
Principal Investigator: Antonio Serra, MD         
Hospital Clinic Villaroel Recruiting
Barcelona, Spain, 08036
Contact: Victoria Martin Yuste, MD       27700vmy@cimb.cat   
Principal Investigator: Victoria Martin Yuste, MD         
Hospital Galdakao-Usansolo Recruiting
Galdakao, Spain, 48960
Contact: Ramon Rumoroso, MD       rumo@secardiologia.es   
Principal Investigator: Ramon Rumoroso, MD         
Cardiovascular Institute - Hospital Clinico San Carlos Recruiting
Madrid, Spain, 28040
Contact: Javier Escaned, MD    34 91 3303289      
Principal Investigator: Javier Escaned, MD         
United Kingdom
Royal Sussex County Hospital - Brighton and Sussex University Hospitals Recruiting
Brighton, United Kingdom, BN2 5BE
Contact: David Hildick-Smith, MD    '+44 1273 696955      
Principal Investigator: David Hildick-Smith, MD         
Royal Infirmary of Edinburgh Recruiting
Edinburgh, United Kingdom, EH16 4SA
Contact: James Spratt, MD    +44 131 536 1000      
Principal Investigator: James Spratt, MD         
Department of Cardiovascular Sciences University of Leicester Recruiting
Leicester, United Kingdom, LE3 9QP
Contact: Anthony Gershlick, MD PhD    +44 7850 57 46 38      
Principal Investigator: Anthony Gershlick, MD PhD         
National Heart and Lung Institute Imperial College Recruiting
London, United Kingdom, SW7 2AZ
Contact: Carlo Di Mario, MD PhD    +44 207 351 8616      
Principal Investigator: Carlo Di Mario, MD PhD         
Sponsors and Collaborators
Euro CTO Club
NHS Research and Development
Biosensors International
Asahi Intecc Co., Ltd.
Principal Investigator: Gerald S Werner, MD PhD Klinikum Darmstadt, Darmstadt Germany
  More Information

Additional Information:
No publications provided

Responsible Party: Euro CTO Club
ClinicalTrials.gov Identifier: NCT01760083     History of Changes
Other Study ID Numbers: 2011-005905-64 
Study First Received: January 1, 2013
Last Updated: February 12, 2015
Health Authority: European Union: European Medicines Agency

Additional relevant MeSH terms:
Angina, Stable
Coronary Occlusion
Angina Pectoris
Cardiovascular Diseases
Chest Pain
Coronary Disease
Heart Diseases
Myocardial Ischemia
Signs and Symptoms
Vascular Diseases

ClinicalTrials.gov processed this record on February 11, 2016