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Cell Therapy in Myocardial Infarction (EMRTCC)

Primary Purpose

Acute Myocardial Infarction

Status
Terminated
Phase
Phase 2
Locations
Brazil
Study Type
Interventional
Intervention
Autologous Bone Marrow Mononuclear Cells (ABMMC) Transplantation
Sponsored by
Ministry of Health, Brazil
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myocardial Infarction focused on measuring Myocardial Infarction, Myocardial Ischemia, Ventricular Remodeling, Bone Marrow Cell Transplantation, Stem cells

Eligibility Criteria

30 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Patients will be eligible if presenting all characteristics described below: ST segment elevation myocardial infarction in two or more contiguous leads, and according to the WHO definition, at least one of the following two: i) Presence of chest pain. ii) Elevation of the myonecrosis markers. Age between 30 and 80 years old. Ejection fraction ≤50% on Echocardiogram (Simpson) and segmentary dysfunction of the infarction area, measured between the 3rd and 5th day post AMI. Among patients submitted to thrombolytic therapy, the angioplasty of the related artery should be preferably done up to 24h after thrombolysis, with a maximum deadline of 72h after thrombolysis. Exclusion Criteria: Patients will be ineligible if presenting any of the characteristics described below: AMI related artery presenting TIMI < 3 at the moment f cell injection. Left Main Coronary Artery Lesion of >50% or multivessel coronariopathy (>70% lesion in vessels with >2,0mm diameter in left anterior descending, circumflex and right coronary territory) indicating the need for CABG or angioplasty with three or more stents implant. Coronary anatomy, after thrombolytic reperfusion, presenting no need for angioplasty with stent implant. Final Diastolic Pression of the LV higher than 30 mmHg during ventriculography for evaluating EF inclusion criteria for the research protocol (item "c" of inclusion criteria). Cardiac arrest or Killip IV AMI at admission with need of ventilatory support. Cardiogenic shock persisting up to the third day after AMI (with need of Intra-aortic balloon pump or vasopressors). AMI mechanical complications (ventricular septal defect, papillary muscle rupture, and left ventricular free wall rupture). Significant valve disease, defined as aortic stenosis (mean systolic pressure gradient across the aortic valve >50mmHg), mitral stenosis with a valvar area less than 1,5 cm,2 moderate to severe aortic and/or mitral regurgitation. Chronic use of immunosuppressive agents. > 2,0 mg/dl creatinine or previous dialysis treatment. Presence of fever on the past 48h before injection glaring active systemic infection according to ACCP/SCCM (American College of Chest Physicians/Society of Critical Care Medicine) sepsis definition. Sustained ventricular tachycardia 48h after AMI. Illicit drugs abuse or alcohol abuse (based on DSM IV). Any co morbidity, with survival impact in two years. Myocarditis Active liver disease COPD in continuous steroids use. Hematological disease, neoplasm, bone disease or hemostatic disturbances. Inflammatory disease or chronicle infectious disease. Presence of definitive implantation of a cardiac pace maker or cardiac defibrillator. Impossibility to reach a cells suspension of 100 million mononuclear cells due to cells paucity in the bone marrow aspirate.

Sites / Locations

  • PROCEP/Hospital Pró-Cardíaco

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Treated Group

Control Group

Arm Description

Intracoronary injection in the infarcted-related artery of 100 million bone marrow mononuclear cells resuspended in a 10 ml solution of saline with autologous serum.

Intracoronary injection in the infarcted-related artery of placebo solution consisting of a saline containing autologous blood serum.

Outcomes

Primary Outcome Measures

Global Left Ventricular Ejection Fraction change

Secondary Outcome Measures

Death
Acute myocardial infarction, stroke and hospital admission due to cardiovascular cause
Reintervention of the AMI related artery and of the non-related artery
Regional wall motion, wall thickening, and volume of late contrast enhancement
Evolutive alterations of the coronarian anatomy, as well as the patency of the coronary stents
Quality of life assessment using the Short-Form 36, Minnesota Living with Heart Failure Questionnaire and Seattle Angina questionnaire
Cost-effectiveness and cost-utility evaluation of autologous bone marrow mononuclear cells implant versus conventional treatment

Full Information

First Posted
July 10, 2006
Last Updated
March 29, 2017
Sponsor
Ministry of Health, Brazil
Collaborators
Pro-Cardiaco Hospital, Hospital do Coracao, Instituto Estadual de Cardiologia Aloysio de Castro, Hospital Cardiológico Costantini, Hospital Universitário Regional do Norte do Paraná - FUEL, Hospital Santa Izabel, Hospital Santa Izabel de Sergipe, Hospital Agamenon, Hospital do Andaraí, Hospital de Messejana, Hospital de Clinicas de Porto Alegre, Faculty of Medicine of Ribeirão Preto (FMRP-USP), Instituto Nacional de Cardiologia de Laranjeiras, Instituto de Cardiologia do Rio Grande do Sul, Hospital São Marcos, Hospital Universitário Oswaldo Cruz - UPE, Real Hospital Português de Beneficência, Hospital Municipal Miguel Couto, Anis Rassi Hospital, Brazil, Federal University of São Paulo, Instituto Dante Pazzanese de Cardiologia, Universidade Federal do Rio de Janeiro, Hospital Bandeirantes, InCor Heart Institute, Hospital Santa Isabel de Blumenau, Federal University of Uberlandia, Hospital TotalCor, Hospital de Clínicas Mario Lioni, Hospital de Clínicas de Niteroi
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1. Study Identification

Unique Protocol Identification Number
NCT00350766
Brief Title
Cell Therapy in Myocardial Infarction
Acronym
EMRTCC
Official Title
Multicenter Prospective Randomized Double Blind Trial of Bone Marrow Mononuclear Cells Transplantation Through Intracoronary Injection in Patients With Acute Myocardial Infarction.
Study Type
Interventional

2. Study Status

Record Verification Date
March 2017
Overall Recruitment Status
Terminated
Why Stopped
Slow recruitment rate and consequent financial exhaustion.
Study Start Date
July 1, 2006 (Actual)
Primary Completion Date
January 21, 2014 (Actual)
Study Completion Date
July 14, 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Ministry of Health, Brazil
Collaborators
Pro-Cardiaco Hospital, Hospital do Coracao, Instituto Estadual de Cardiologia Aloysio de Castro, Hospital Cardiológico Costantini, Hospital Universitário Regional do Norte do Paraná - FUEL, Hospital Santa Izabel, Hospital Santa Izabel de Sergipe, Hospital Agamenon, Hospital do Andaraí, Hospital de Messejana, Hospital de Clinicas de Porto Alegre, Faculty of Medicine of Ribeirão Preto (FMRP-USP), Instituto Nacional de Cardiologia de Laranjeiras, Instituto de Cardiologia do Rio Grande do Sul, Hospital São Marcos, Hospital Universitário Oswaldo Cruz - UPE, Real Hospital Português de Beneficência, Hospital Municipal Miguel Couto, Anis Rassi Hospital, Brazil, Federal University of São Paulo, Instituto Dante Pazzanese de Cardiologia, Universidade Federal do Rio de Janeiro, Hospital Bandeirantes, InCor Heart Institute, Hospital Santa Isabel de Blumenau, Federal University of Uberlandia, Hospital TotalCor, Hospital de Clínicas Mario Lioni, Hospital de Clínicas de Niteroi

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to determine cell therapy efficacy in patients with ST elevation acute myocardial infarction (STEMI)
Detailed Description
This study protocol describes a randomized double blind clinical trial, which main purpose is to evaluate the effect of the autologous bone marrow mononuclear cell (ABMMC) implant in 300 Brazilian patients with ST elevation acute myocardial infarction (STEMI). Double blind study design was chosen for this trial, based on several phase I and II safety trials of intracoronary autologous bone marrow stem cells transplantation, already published. The study coordinator committee, supported by the Brazilian Health Ministry, therefore has proposed a phase III trial with the purpose of proving the efficacy of this kind of therapy, for a population with a high risk of developing heart failure and of death by cardiovascular cause. Thus, in this protocol we propose a prospective, double blind, controlled and randomized trial to evaluate the effect of ABMMC transplantation through intracoronary infusion, on systolic left ventricle (LV) function. The main hypothesis of this trial is that patients submitted to autologous bone marrow stem cell implant, after 6 months follow up, will present a 5% relative increase of the ejection fraction (EF) comparing to control group.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myocardial Infarction
Keywords
Myocardial Infarction, Myocardial Ischemia, Ventricular Remodeling, Bone Marrow Cell Transplantation, Stem cells

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Parallel Assignment
Model Description
Double Blind Randomized Controlled Trial
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Control group received injection of saline with 5% autologous serum without the suspension of mononuclear cells.
Allocation
Randomized
Enrollment
166 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treated Group
Arm Type
Experimental
Arm Description
Intracoronary injection in the infarcted-related artery of 100 million bone marrow mononuclear cells resuspended in a 10 ml solution of saline with autologous serum.
Arm Title
Control Group
Arm Type
Placebo Comparator
Arm Description
Intracoronary injection in the infarcted-related artery of placebo solution consisting of a saline containing autologous blood serum.
Intervention Type
Procedure
Intervention Name(s)
Autologous Bone Marrow Mononuclear Cells (ABMMC) Transplantation
Other Intervention Name(s)
Catheter based stem cell delivery
Intervention Description
Catheter based stem cells delivery of 100 million cells resuspended in a 10 ml solution of saline with autologous serum. About 100 ml of Bone Marrow aspirate were harvested from iliac crest between the fifth and seventh day after myocardial infarction. ABMMC were isolated by density gradient centrifugation on Ficoll-PaqueTM plus (Amersham Biosciences) and manipulated under aseptic conditions for injection, after being filtered through 100 um nylon mesh to remove cell aggregates.
Primary Outcome Measure Information:
Title
Global Left Ventricular Ejection Fraction change
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Death
Time Frame
30 days, 90 days, 6 months and 1 year
Title
Acute myocardial infarction, stroke and hospital admission due to cardiovascular cause
Time Frame
30 days, 90 days, 6 months and 1 year
Title
Reintervention of the AMI related artery and of the non-related artery
Time Frame
30 days, 90 days, 6 months and 1 year
Title
Regional wall motion, wall thickening, and volume of late contrast enhancement
Time Frame
Baseline and 6 months
Title
Evolutive alterations of the coronarian anatomy, as well as the patency of the coronary stents
Time Frame
6 months
Title
Quality of life assessment using the Short-Form 36, Minnesota Living with Heart Failure Questionnaire and Seattle Angina questionnaire
Time Frame
Baseline, 6 months and 1 year
Title
Cost-effectiveness and cost-utility evaluation of autologous bone marrow mononuclear cells implant versus conventional treatment
Time Frame
1 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
30 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients will be eligible if presenting all characteristics described below: ST segment elevation myocardial infarction in two or more contiguous leads, and according to the WHO definition, at least one of the following two: i) Presence of chest pain. ii) Elevation of the myonecrosis markers. Age between 30 and 80 years old. Ejection fraction ≤50% on Echocardiogram (Simpson) and segmentary dysfunction of the infarction area, measured between the 3rd and 5th day post AMI. Among patients submitted to thrombolytic therapy, the angioplasty of the related artery should be preferably done up to 24h after thrombolysis, with a maximum deadline of 72h after thrombolysis. Exclusion Criteria: Patients will be ineligible if presenting any of the characteristics described below: AMI related artery presenting TIMI < 3 at the moment f cell injection. Left Main Coronary Artery Lesion of >50% or multivessel coronariopathy (>70% lesion in vessels with >2,0mm diameter in left anterior descending, circumflex and right coronary territory) indicating the need for CABG or angioplasty with three or more stents implant. Coronary anatomy, after thrombolytic reperfusion, presenting no need for angioplasty with stent implant. Final Diastolic Pression of the LV higher than 30 mmHg during ventriculography for evaluating EF inclusion criteria for the research protocol (item "c" of inclusion criteria). Cardiac arrest or Killip IV AMI at admission with need of ventilatory support. Cardiogenic shock persisting up to the third day after AMI (with need of Intra-aortic balloon pump or vasopressors). AMI mechanical complications (ventricular septal defect, papillary muscle rupture, and left ventricular free wall rupture). Significant valve disease, defined as aortic stenosis (mean systolic pressure gradient across the aortic valve >50mmHg), mitral stenosis with a valvar area less than 1,5 cm,2 moderate to severe aortic and/or mitral regurgitation. Chronic use of immunosuppressive agents. > 2,0 mg/dl creatinine or previous dialysis treatment. Presence of fever on the past 48h before injection glaring active systemic infection according to ACCP/SCCM (American College of Chest Physicians/Society of Critical Care Medicine) sepsis definition. Sustained ventricular tachycardia 48h after AMI. Illicit drugs abuse or alcohol abuse (based on DSM IV). Any co morbidity, with survival impact in two years. Myocarditis Active liver disease COPD in continuous steroids use. Hematological disease, neoplasm, bone disease or hemostatic disturbances. Inflammatory disease or chronicle infectious disease. Presence of definitive implantation of a cardiac pace maker or cardiac defibrillator. Impossibility to reach a cells suspension of 100 million mononuclear cells due to cells paucity in the bone marrow aspirate.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hans F Dohmann, MD
Organizational Affiliation
PROCEP/Pró-Cardíaco Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
PROCEP/Hospital Pró-Cardíaco
City
Rio de Janeiro
ZIP/Postal Code
22280-000
Country
Brazil

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
18598362
Citation
Dohmann HF, Silva SA, Sousa AL, Braga AM, Branco RV, Haddad AF, Oliveira MA, Moreira RC, Tuche FA, Peixoto CM, Tura BR, Borojevic R, Ribeiro JP, Nicolau JC, Nobrega AC, Carvalho AC. Multicenter double blind trial of autologous bone marrow mononuclear cell transplantation through intracoronary injection post acute myocardium infarction - MiHeart/AMI study. Trials. 2008 Jul 3;9:41. doi: 10.1186/1745-6215-9-41.
Results Reference
background
PubMed Identifier
17233910
Citation
Tura BR, Martino HF, Gowdak LH, dos Santos RR, Dohmann HF, Krieger JE, Feitosa G, Vilas-Boas F, Oliveira SA, Silva SA, Bozza AZ, Borojevic R, de Carvalho AC. Multicenter randomized trial of cell therapy in cardiopathies - MiHeart Study. Trials. 2007 Jan 18;8:2. doi: 10.1186/1745-6215-8-2.
Results Reference
background

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Cell Therapy in Myocardial Infarction

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