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Very Early veRsus Deferred Invasive Evaluation Using Computerized Tomography in Patients With Acute Coronary Syndromes (VERDICT-EDI)

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ClinicalTrials.gov Identifier: NCT02061891
Recruitment Status : Active, not recruiting
First Posted : February 13, 2014
Last Update Posted : December 12, 2022
University Hospital, Gentofte, Copenhagen
Information provided by (Responsible Party):
Klaus Fuglsang Kofoed, Rigshospitalet, Denmark

Brief Summary:

The aim of this study is to evaluate if acute invasive coronary evaluation and treatment conducted within 12 hours of diagnosis improves clinical outcome compared to a deferred, subacute strategy in patients with unstable angina pectoris (UAP) / non-ST segment elevation myocardial infarction (NSTEMI) Acute coronary syndrome (ACS) Furthermore, in an observational design the potential clinical benefit of coronary computed tomography angiography (CCTA) to select patients for invasive investigation and treatment in the two treatment arms (acute vs deferred) is evaluated.

The following main hypothesis will be tested:

  • Very early invasive coronary investigation improves clinical outcome in patients with UAP/NSTEMI-ACS
  • CCTA performed before invasive coronary investigation will improve clinical management of patients with UAP/NSTEMI-ACS

Condition or disease Intervention/treatment Phase
Coronary Artery Disease Procedure: Invasive coronary evaluation (Deferred) Procedure: Invasive coronary evaluation (Acute) Not Applicable

Detailed Description:

MATERIAL Consecutive patients suspected of UAP/NSTEMI will be screened for participation in the study. Only patients deemed clinically suited for invasive coronary evaluation and treatment will be included. A total of 2500 patients will be included in the trial at Departments of Cardiology of Danish Hospitals.

METHODS If the patients accept participation in the trial a computerized 1:1 randomization for acute invasive coronary evaluation (Intervention group - within 12 hours from time of diagnosis) or for deferred invasive evaluation (Control group - no later than 72 hours from time of diagnosis). All included patients undergo CCTA prior to invasive coronary evaluation, except for patient with moderately reduced renal function (se below). The treating invasive cardiologist will remain blinded to observational CCTA data. Patients with endstage renal disease in dialysis may undergo CCTA. CCTA data recorded as part of the research protocol will not be made available for the treating physician.

SECONDARY EXCLUSION Based on post-hoc expert clinical evaluation patients not having UAP/NSTEMI-ACS (arrythmias, pulmonary oedema, missed STEMI, pneumonia, Pulmonary emboli) will be excluded from analysis of difference between outcome measures in treatment strategy groups.

STATISTICAL METHODS Patients with UAP/NSTEMI-ACS are based on previous studies expected to have an event rate of 15% within 1 year and 50% at 4 years of the primary combined endpoint: all cause mortality, non-fatal recurrent myocardial infarction, hospitalisation for refractory ischemia or heart failure. In order to demonstrate a reduction of 25% within 3 years 711 patients in each group are needed. The study is powered to detect a clinical relevant reduction in mortality or heart failure hospitalization with a total of 2500 patients.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 2500 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Entire Danish Initiative To ImrpOve Revascularization Strategies (EDITORS) - A Randomised Evaluation of Clinical Outcome After Acute or Deferred Invasive Intervention Integrated With MDCT Imaging in Patients With Acute Coronary Syndromes
Study Start Date : November 2010
Actual Primary Completion Date : June 2016
Estimated Study Completion Date : May 2030

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Active Comparator: Deferred invasive evaluation
Deferred invasive coronary evaluation and revascularization (PCI/CABG) within 72 hours from time of clinical diagnosis (CONTROL group)
Procedure: Invasive coronary evaluation (Deferred)
Invasive coronary angiography and revascularization (PCI/CABG)

Experimental: Very early invasive evaluation
Acute invasive coronary evaluation within 12 hours from time of diagnosis - INTERVENTION group
Procedure: Invasive coronary evaluation (Acute)
Invasive coronary angiography and revascularization (PCI/CABG)

Primary Outcome Measures :
  1. Composite clinical endpoint [ Time Frame: 3 years ]
    Composite endpoint of all cause mortality, non-fatal recurrent acute myocardial infarction, hospitalisation for refractory ischemia (acute coronary syndrome) or heart failure

Secondary Outcome Measures :
  1. Bleeding [ Time Frame: During index hospitalization - an expected average of 5 days ]
    Major and minor bleeding according to TIMI and BARC classification systems

  2. Non-bleeding, invasive procedure related complications [ Time Frame: During index hospitalization - an expected average of 5 days ]
    Invasive procedure related acute myocardial infarction, embolic stroke, cardiac arrest

  3. Death [ Time Frame: 3 and 5 years ]
    All-cause death

  4. Non-fatal acute myocardial infarction [ Time Frame: 3 and 5 years ]
  5. Hospital admittance due to refractory myocardial ischemia (acute coronary syndrome) [ Time Frame: 3 and 5 years ]
  6. Repeat coronary revascularization [ Time Frame: 3 and 5 years ]
    Recorded from 30 days post-index procedure

  7. Hospital admittance due to left ventricular heart failure [ Time Frame: 3 and 5 years ]
  8. GRACE Risk Score [ Time Frame: 3 and 5 years ]
    All primary and secondary endpoints stratified by GRACE score at a threshold of 140

Other Outcome Measures:
  1. CCTA diagnostic accuracy [ Time Frame: Within 30 days after performed CCTA and ICA ]
    Determinants of diagnostic accuracy of CCTA for the identification of >50% and >70% coronary artery stenosis by invasive coronary angiography in both treatment strategy groups

  2. CCTA guided treatment strategy [ Time Frame: Within 30 days after performed CCTA and ICA ]
    Prediction of clinical treatment strategy based on CCTA - and the potential value of CCTA guided triage in terms of optimized patient management. Evaluation will be performed blinded to ICA findings.

  3. CCTA prediction of clinical outcome [ Time Frame: 3 and 5 years ]
    Clinical prognostic value of coronary pathology, cardiac and non-cardiac pathology identified by CCTA

Information from the National Library of Medicine

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

Inclusion Criteria:

Patients with clinical suspicion of of UAP/NSTEMI acute coronary syndrome deemed suitable for invasive evaluation and treatment will be included in the study.

  • Age> 18 years
  • At least one of the following:
  • ECG abnormalities suggestive of myocardial ischemia (newly developed ST segment depression, horizontal or descending >= 0,05mV in two anatomically adjacent leads and/or T-wave inversion >0,01 mV in two leads with prominent R wave or R/S ratio >1
  • Elevated myocardial ischemia biomarkers (Troponin, CK-MB)

Exclusion Criteria:

  • Pregnancy
  • Circumstances preventing the patient from reading and/or understanding the research protocol information
  • Clinical indication for acute invasive coronary angiography - severe chest pain despite intravenous nitroglycerin infusion or hemodynamic instability
  • Expected survival of less than 1 year
  • Known allergy/hypersensitivity of pharmacological platelet inhibitors and/or iodine contrast that cannot be prevented medically

Patients with known eGFR below 60 ml/min will not undergo CCTA, whereas patients in dialysis will undergo the entire study protocol

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): NCT02061891

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Department of Cardiology and Radiology, Rigshospitalet, The Heart Center, Capital Region of Copenhagen, University of Copenhagen
Copenhagen, Denmark, 2100
Sponsors and Collaborators
Rigshospitalet, Denmark
University Hospital, Gentofte, Copenhagen
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Study Chair: Lars V Køber, MD, DmSc Department of Cardiology, Rigshospitalet, The Heart Center, Capital Region of Copenhagen, University of Copenhagen, Denmark
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: Klaus Fuglsang Kofoed, Associate Professor, Rigshospitalet, Denmark
ClinicalTrials.gov Identifier: NCT02061891    
Other Study ID Numbers: H-4-2010-039
EDITORS ( Other Identifier: The Danish Council for Strategic Research (09-066994) )
First Posted: February 13, 2014    Key Record Dates
Last Update Posted: December 12, 2022
Last Verified: December 2022
Keywords provided by Klaus Fuglsang Kofoed, Rigshospitalet, Denmark:
Coronary Stenosis
Coronary Artery Disease
Acute coronary syndrome
Percutaneous Coronary Intervention
Multidetector Computed Tomography
Additional relevant MeSH terms:
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Coronary Artery Disease
Myocardial Ischemia
Coronary Disease
Acute Coronary Syndrome
Heart Diseases
Cardiovascular Diseases
Arterial Occlusive Diseases
Vascular Diseases