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Percutaneous Coronary Intervention Versus Medical Treatment for Stable Angina Pectoris (DANANGINA)

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ClinicalTrials.gov Identifier: NCT04496648
Recruitment Status : Recruiting
First Posted : August 3, 2020
Last Update Posted : August 3, 2020
Sponsor:
Information provided by (Responsible Party):
Sune Ammentorp Haahr-Pedersen, Herlev and Gentofte Hospital

Brief Summary:
Patients with ischemic heart disease and symptoms due to lack of oxygen to the heart on exertion (stable angina pectoris) are usually treated by either percutaneous coronary intervention (PCI) or optimal medical therapy (OMT) alone. In patients with mild to moderate coronary artery disease the prognostic impact of PCI is probably limited. Furthermore it is unclear which treatment is superior in terms of relieving symptoms (PCI or OMT). In this trial, patients with mild to moderate coronary artery disease will be randomized to PCI or sham-PCI. All patients will undergo optimal medical therapy. It is hypothesized that PCI is superior to sham-PCI in patients with stable angina pectoris undergoing optimal medical therapy in terms of symptom-relief.

Condition or disease Intervention/treatment Phase
Coronary Heart Disease Stable Angina Ischemic Heart Disease Procedure: Percutaneous Coronary Intervention Procedure: Sham-percutaneous coronary intervention Not Applicable

Detailed Description:

Ischemic heart disease (IHD) is a major cause of death and disability worldwide. Patients with ischemic heart disease and symptoms due to lack of oxygen to the heart on exertion (stable angina pectoris) are usually treated by either percutaneous coronary intervention (PCI) or optimal medical therapy (OMT) alone. In patients with mild to moderate coronary artery disease the prognostic impact of PCI is probably limited. Furthermore it is unclear which treatment is superior in terms of relieving symptoms (PCI or OMT). Both treatments are effective in terms of reducing symptoms, but come with potential side effects.

PCI has in previous trials failed to show superiority compared to medical therapy in patients with stable angina pectoris. However, many visually significant lesions do not limit the blood flow significantly to the heart, and stenting such a lesion only exposes the patient to the risk of side effects of intervention. In recent years it has therefore become guideline-recommended practice to perform physiological test to evaluate a potential stenosis. During an angiography this is most often done using fractional flow reserve (FFR).

This study tests the optimal strategy for treatment of angina-symptoms in patients with stable pectoris. PCI is performed with modern stent designs and use of intravascular functional testing (FFR-guided PCI) and compared to sham-PCI.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 450 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Randomized patient-blind sham-controlled trial
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
Official Title: The Danish Randomized Sham-Controlled Study of Invasive Versus Medical Treatment for Stable Angina Pectoris
Actual Study Start Date : June 15, 2020
Estimated Primary Completion Date : May 31, 2022
Estimated Study Completion Date : September 30, 2022

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Angina

Arm Intervention/treatment
Active Comparator: Percutaneous Coronary Intervention
Conventional PCI and optimal medical therapy
Procedure: Percutaneous Coronary Intervention
Percutaneous coronary intervention with drug-eluting stents and modern techniques
Other Name: PCI

Placebo Comparator: Sham-percutaneous coronary intervention
Sham-PCI and optimal medical therapy
Procedure: Sham-percutaneous coronary intervention
Sham-PCI procedure for at least 15 minutes that includes shifting the C-arm, reinserting the FFR-wire in the catheter and inflating the device.
Other Name: sham-PCI




Primary Outcome Measures :
  1. Combined endpoint of strategy success [ Time Frame: 3 months ]
    Number of patients without angina (freedom from angina) and without hospital admission for intolerable stable angina pectoris, unstable angina pectoris, or acute myocardial infarction


Secondary Outcome Measures :
  1. Number of all-cause death, any myocardial infarction, stroke, major bleeding, and severe drug reaction [ Time Frame: 3 months ]
    see above

  2. Number of conversions to PCI for procedural complication (sham-PCI group) [ Time Frame: 3 months ]
    see above

  3. Number of patients with hospital admission for intolerable stable angina, unstable angina pectoris, or acute myocardial infarction [ Time Frame: 3 months ]
    see above

  4. Number of patients in CCS class 1, 2, and 3, respectively, without hospital admission for intolerable stable angina, unstable angina pectoris, or acute myocardial infarction [ Time Frame: 3 months ]
    see above

  5. Number of patients with clinically driven coronary revascularization [ Time Frame: 3 months ]
    see above

  6. Change in CCS class [ Time Frame: 3 months ]
    see above

  7. Use of antianginal agents [ Time Frame: 3 months ]
    0, 1, 2, or 3 agents

  8. Quality of life score [ Time Frame: 3 months ]
    5- level EQ-5D (EQ-5D-5L) questionnaire. Each dimension will be scored from 0-5 where a higher score means a better outcome. .

  9. Change in angina-specific quality of life [ Time Frame: 3 months ]
    Seattle Angina Questionnaire 7. Values will range from 0-100 where higher score means better outcome.

  10. Primary composite endpoint in the modified intention-to-treat population [ Time Frame: 3 months ]
    The modified intention-to-treat population is comprised of patients who underwent the study procedure and follow-up without overt or formal unblinding.

  11. Change in CCS class in the modified intention-to-treat population [ Time Frame: 3 months ]
    The modified intention-to-treat population is comprised of patients who underwent the study procedure and follow-up without overt or formal unblinding.

  12. Change in Seattle Angina Questionnaire 7 score in the modified intention-to-treat population [ Time Frame: 3 months ]
    The modified intention-to-treat population is comprised of patients who underwent the study procedure and follow-up without overt or formal unblinding. Values will range from 0-100 where higher score means better outcome.

  13. Change in generic quality of life (EQ-5D-5L) in the modified intention-to-treat population [ Time Frame: 3 months ]
    The modified intention-to-treat population is comprised of patients who underwent the study procedure and follow-up without overt or formal unblinding. Each dimension will be scored from 0-5 where a higher score means a better outcome.



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Ages Eligible for Study:   18 Years to 85 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion criteria

  • Age 18-85 years
  • Patients with stable angina pectoris undergoing elective coronary angiography
  • Canadian Cardiovascular Society (CCS) class 2 or 3
  • Informed consent
  • Lesions in one or more coronary vessels with a diameter >2.5 mm with FFR-values ≤0.80, and suitable for complete revascularization with PCI.

Exclusion criteria

  • Contraindication to PCI or dual antiplatelet therapy (DAPT)
  • Use of or indication for oral anticoagulants (OAC) or novel oral anticoagulants (NOAC)
  • Use of clopidogrel
  • Life expectancy of less than 2 years
  • Severe valvular disease
  • Severe comorbidity
  • Acute coronary event within the past 12 months
  • Left ventricular ejection fraction ≤35%.
  • Renal function with estimated glomerular filtration rate (eGFR) <30 mL/min
  • Pregnant or nursing
  • Severe coronary artery disease (left main stenosis, 3-vessel disease, proximal left anterior descending stenosis, chronic total occlusion of major vessel)
  • Coronary disease where complete revascularization by PCI is considered difficult or impossible.

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): NCT04496648


Contacts
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Contact: Sune Ammentorp Haahr-Pedersen, MD +45 38672267 ext +4530220889 sunped01@regionh.dk
Contact: Niels Thue Olsen, MD, PhD

Locations
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Denmark
Gentofte University Hospital Recruiting
Gentofte, Copenhagen, Denmark, 2900
Contact: Niels Thue Olsen, MD, PhD    +45 38 67 25 60    niels.thue.olsen@regionh.dk   
Sponsors and Collaborators
Herlev and Gentofte Hospital
Investigators
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Principal Investigator: Ole Havndrup Zealand Unviersity Hospital
Principal Investigator: Ole Ahlehoff Odense University Hospital
Principal Investigator: Ashkan Eftekhari Aarhus University Hospital Skejby
Principal Investigator: Martin Kirk Aalborg University Hospital
Principal Investigator: Rikke Sørensen Rigshospitalet, Denmark
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Responsible Party: Sune Ammentorp Haahr-Pedersen, Primary Investigator, Herlev and Gentofte Hospital
ClinicalTrials.gov Identifier: NCT04496648    
Other Study ID Numbers: H-18009651
First Posted: August 3, 2020    Key Record Dates
Last Update Posted: August 3, 2020
Last Verified: July 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: Data will be shared upon request.
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Informed Consent Form (ICF)
Clinical Study Report (CSR)
Analytic Code
Time Frame: 1 year after publication
Access Criteria: Upon request

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Sune Ammentorp Haahr-Pedersen, Herlev and Gentofte Hospital:
Atherosclerosis
Fractional flow reserve
Optimal medical therapy
Antianginal
Percutaneous Coronary Intervention
Additional relevant MeSH terms:
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Heart Diseases
Angina Pectoris
Coronary Disease
Coronary Artery Disease
Myocardial Ischemia
Angina, Stable
Cardiovascular Diseases
Vascular Diseases
Chest Pain
Pain
Neurologic Manifestations
Arteriosclerosis
Arterial Occlusive Diseases