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Statin and Atheroma Vulnerability Evaluation (STABLE)

Primary Purpose

Coronary Artery Disease

Status
Completed
Phase
Phase 4
Locations
Korea, Republic of
Study Type
Interventional
Intervention
Rosuvastatin calcium 40mg
Rosuvastatin calcium10mg
Sponsored by
Seung-Jung Park
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Coronary Artery Disease focused on measuring rosuvastatin

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male or female at least 18 years of age inclusive.
  2. Patients with stable (CCS class 1 to 4) or acute coronary syndromes (unstable angina pectoris Braunwald class IB, IC, IIB, IIC, IIIB, IIIC or NSTEMI) or patients with atypical chest pain or without symptoms but having documented myocardial ischemia who will undergo either planned coronary angiography, or percutaneous coronary intervention
  3. Non-culprit de novo lesion in a native coronary artery with at least one deferred coronary lesion with 1) visually-estimated angiographic % diameter stenosis 20-50% or 2) % diameter stenosis >50% without any evidence of inducible ischemia (FFR≥0.8 or negative perfusion on thiallium scan or negative treadmill test). Index lesion should have at least 1 fibroatheroma or TCFA.
  4. The patient or guardian agrees to the study protocol and the schedule of clinical and angiographic follow-up, and provides informed, written consent, as approved by the appropriate Institutional Review Board/Ethical Committee of the respective clinical site

Exclusion Criteria:

  1. Planned cardiac surgery (e.g., CABG, valve repair or replacement, or aneurysmectomy) or planned major non-cardiac surgery within the study period
  2. Stroke or resuscitated sudden death in the past 6 months
  3. Chronic disease requiring treatment with oral, intravenous, or intra-articular corticosteroids (use of topical, inhaled, or nasal corticosteroids is permissible)
  4. Untreated hyperthyroidism, or hypothyroidism with TSH levels more than 1.5 times upper limit of normal
  5. A diagnosis of cancer (other than superficial squamous or basal cell skin cancer) in the past 3 years or current treatment for the active cancer
  6. Any clinically significant abnormality identified at the screening visit, physical examination, laboratory tests, or electrocardiogram which, in the judgment of the Investigator, would preclude safe completion of the study
  7. Evidence of congestive heart failure, or left ventricular ejection fraction < 40%
  8. Significant renal disease manifested by serum creatinine > 2.0mg/dL, or creatinine clearance of < 40 ml/min (by Cockcroft-Gault method)
  9. Hepatic disease or biliary tract obstruction, or significant hepatic enzyme elevation (ALT or AST > 3 times upper limit of normal)
  10. History of myopathy or elevated creatine kinase (CK) > 3 times upper normal limit at screening
  11. History of adult asthma manifested by bronchospasm in the past 6 months, or currently taking regular anti-asthmatic medication(s)
  12. Unwillingness or inability to comply with the procedures described in this protocol
  13. History of any arterial bypass or angioplastic intervention involving the target vessel
  14. The luminal narrowing in the target vessel or in the left main coronary artery >50% by visual inspection of angiogram
  15. Luminal diameter of the target vessel < 2.5mm by visual inspection of coronary angiogram
  16. Presence of thrombus or complex plaque morphology in the target vessel that suggests a high likelihood of distal embolism
  17. Severe tortuosity of the target vessel or any other anatomical reasons that the investigator deems inappropriate for IVUS procedures

Sites / Locations

  • Asan Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Rosuvastatin calcium 40mg

Rosuvastatin calcium10mg

Arm Description

high-dose (40mg rosuvastatin)

low-dose statin (10mg rosuvastatin)

Outcomes

Primary Outcome Measures

Percent compositional change of coronary plaque in the entire pullback length Percent compositional c Percent hange of coronary plaque in the entire pullback length of "target segment" (within both proximal and distal fiduciary sites)

Secondary Outcome Measures

VH-IVUS parameters
Conventional IVUS parameters
OCT Sub-study parameters
Serum biomarkers

Full Information

First Posted
October 18, 2009
Last Updated
December 23, 2014
Sponsor
Seung-Jung Park
Collaborators
CardioVascular Research Foundation, Korea
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1. Study Identification

Unique Protocol Identification Number
NCT00997880
Brief Title
Statin and Atheroma Vulnerability Evaluation
Acronym
STABLE
Official Title
Effect of High-Dose and Low-Dose Statin for Coronary Plaque Modification
Study Type
Interventional

2. Study Status

Record Verification Date
December 2014
Overall Recruitment Status
Completed
Study Start Date
April 2010 (undefined)
Primary Completion Date
December 2014 (Actual)
Study Completion Date
December 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Seung-Jung Park
Collaborators
CardioVascular Research Foundation, Korea

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to evaluate the effect of statin therapy on the modification of atherosclerotic plaque composition and vulnerability in non-intervened coronary arteries with mild to moderate stenosis using VH-IVUS and OCT.
Detailed Description
At present, there is no proven drug or modality to stabilize the vulnerable plaques. A number of drugs that are beneficial for patients with coronary disease may act in part by improving the stability of plaques that are vulnerable for future rupture. Especially, Lipid-lowering therapy, particularly with statins, can stabilize vulnerable plaques or those that have already ruptured by improving endothelial function and reducing thrombogenicity, platelet aggregation, and possibly inflammation. As the atherosclerotic disease has progressed, there is an increase of the atherosclerotic plaque amounts. However, the changes of specific plaque compositions within the atherosclerotic lesions have not been sufficiently evaluated. Previous pathologic findings reported that there was a significant relation between the plaque size and necrotic core size.Conventional grey-scale intravascular ultrasound (IVUS) has significant limitations in accurately assessing atheromatous plaque composition. These limitations have been partially addressed by radiofrequency signal processing with spectral analysis of the back-scattered ultrasound signals. Using this technology, Virtual Histology (VH) IVUS is capable of characterizing plaque as calcified (white), fibrotic (dark-green), fibrofatty (yellow-green), and necrotic core (red). In addition, optical coherence tomography (OCT) is a light-based imaging modality that can be used in biological systems to study tissues in vivo with near-histologic, ultrahigh resolution. The rationale for intravascular application of OCT is its potential for in vivo visualizations of the coronary artery microstructure. This unique image resolution of OCT offers the potential to detect key features of vulnerable plaque in vivo. Beyond the inherent limitations of angioscopy and intravascular ultrasound, OCT might offer a much higher sensitivity in the detection of necrotic/lipid cores within coronary atheromas. Therefore, plaque characterization using VH-IVUS and OCT may provide detailed morphologic insights of plaque vulnerability. We hypothesized that statin would provide benefits to stabilize coronary plaque composition by LDL-reduction and/or a pleiotropic effect. We also hypothesized that high-dose statin would be more beneficial in reducing the vulnerable plaque and stabilizing the vulnerable plaque composition than low-dose statin.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Coronary Artery Disease
Keywords
rosuvastatin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderOutcomes Assessor
Allocation
Randomized
Enrollment
312 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Rosuvastatin calcium 40mg
Arm Type
Experimental
Arm Description
high-dose (40mg rosuvastatin)
Arm Title
Rosuvastatin calcium10mg
Arm Type
Active Comparator
Arm Description
low-dose statin (10mg rosuvastatin)
Intervention Type
Drug
Intervention Name(s)
Rosuvastatin calcium 40mg
Other Intervention Name(s)
CRESTOR® 40mg
Intervention Description
Rosuvastatin calcium 40mg
Intervention Type
Drug
Intervention Name(s)
Rosuvastatin calcium10mg
Other Intervention Name(s)
CRESTOR® 10mg
Intervention Description
Rosuvastatin 10mg
Primary Outcome Measure Information:
Title
Percent compositional change of coronary plaque in the entire pullback length Percent compositional c Percent hange of coronary plaque in the entire pullback length of "target segment" (within both proximal and distal fiduciary sites)
Time Frame
12months
Secondary Outcome Measure Information:
Title
VH-IVUS parameters
Time Frame
12months
Title
Conventional IVUS parameters
Time Frame
12months
Title
OCT Sub-study parameters
Time Frame
12months
Title
Serum biomarkers
Time Frame
12months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female at least 18 years of age inclusive. Patients with stable (CCS class 1 to 4) or acute coronary syndromes (unstable angina pectoris Braunwald class IB, IC, IIB, IIC, IIIB, IIIC or NSTEMI) or patients with atypical chest pain or without symptoms but having documented myocardial ischemia who will undergo either planned coronary angiography, or percutaneous coronary intervention Non-culprit de novo lesion in a native coronary artery with at least one deferred coronary lesion with 1) visually-estimated angiographic % diameter stenosis 20-50% or 2) % diameter stenosis >50% without any evidence of inducible ischemia (FFR≥0.8 or negative perfusion on thiallium scan or negative treadmill test). Index lesion should have at least 1 fibroatheroma or TCFA. The patient or guardian agrees to the study protocol and the schedule of clinical and angiographic follow-up, and provides informed, written consent, as approved by the appropriate Institutional Review Board/Ethical Committee of the respective clinical site Exclusion Criteria: Planned cardiac surgery (e.g., CABG, valve repair or replacement, or aneurysmectomy) or planned major non-cardiac surgery within the study period Stroke or resuscitated sudden death in the past 6 months Chronic disease requiring treatment with oral, intravenous, or intra-articular corticosteroids (use of topical, inhaled, or nasal corticosteroids is permissible) Untreated hyperthyroidism, or hypothyroidism with TSH levels more than 1.5 times upper limit of normal A diagnosis of cancer (other than superficial squamous or basal cell skin cancer) in the past 3 years or current treatment for the active cancer Any clinically significant abnormality identified at the screening visit, physical examination, laboratory tests, or electrocardiogram which, in the judgment of the Investigator, would preclude safe completion of the study Evidence of congestive heart failure, or left ventricular ejection fraction < 40% Significant renal disease manifested by serum creatinine > 2.0mg/dL, or creatinine clearance of < 40 ml/min (by Cockcroft-Gault method) Hepatic disease or biliary tract obstruction, or significant hepatic enzyme elevation (ALT or AST > 3 times upper limit of normal) History of myopathy or elevated creatine kinase (CK) > 3 times upper normal limit at screening History of adult asthma manifested by bronchospasm in the past 6 months, or currently taking regular anti-asthmatic medication(s) Unwillingness or inability to comply with the procedures described in this protocol History of any arterial bypass or angioplastic intervention involving the target vessel The luminal narrowing in the target vessel or in the left main coronary artery >50% by visual inspection of angiogram Luminal diameter of the target vessel < 2.5mm by visual inspection of coronary angiogram Presence of thrombus or complex plaque morphology in the target vessel that suggests a high likelihood of distal embolism Severe tortuosity of the target vessel or any other anatomical reasons that the investigator deems inappropriate for IVUS procedures
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Seung-Jung Park, MD,PhD
Organizational Affiliation
Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Asan Medical Center
City
Seoul
State/Province
Republic of Korea
ZIP/Postal Code
138-736
Country
Korea, Republic of

12. IPD Sharing Statement

Citations:
PubMed Identifier
28679524
Citation
Kwon O, Kang SJ, Kang SH, Lee PH, Yun SC, Ahn JM, Park DW, Lee SW, Kim YH, Lee CW, Han KH, Park SW, Park SJ. Relationship Between Serum Inflammatory Marker Levels and the Dynamic Changes in Coronary Plaque Characteristics After Statin Therapy. Circ Cardiovasc Imaging. 2017 Jul;10(7):e005934. doi: 10.1161/CIRCIMAGING.116.005934.
Results Reference
derived
PubMed Identifier
27081016
Citation
Park SJ, Kang SJ, Ahn JM, Chang M, Yun SC, Roh JH, Lee PH, Park HW, Yoon SH, Park DW, Lee SW, Kim YH, Lee CW, Mintz GS, Han KH, Park SW. Effect of Statin Treatment on Modifying Plaque Composition: A Double-Blind, Randomized Study. J Am Coll Cardiol. 2016 Apr 19;67(15):1772-1783. doi: 10.1016/j.jacc.2016.02.014.
Results Reference
derived

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Statin and Atheroma Vulnerability Evaluation

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