Ranolazine for Incomplete Vessel Revascularization Post-Percutaneous Coronary Intervention (PCI) (RIVER-PCI)
Coronary Artery Disease, Angina Pectoris
About this trial
This is an interventional treatment trial for Coronary Artery Disease
Eligibility Criteria
Inclusion Criteria:
- Written informed consent
- Males and females aged 18 years and older
- History of chronic angina defined as at least 2 episodes of anginal pain or discomfort in the chest, jaw, shoulder, back, neck, or arm that is precipitated by exertion or emotional stress, and relieved by rest or sublingual nitroglycerin, which occurred on at least 2 separate days and at least 14 days prior to PCI (in the case of staged PCI procedures, at least 14 days prior to the first PCI in the series). Participants may or may not have additional angina episodes within the 14 days prior to their first PCI in the series, as well as any time prior to Randomization.
PCI for any indication (ACS or non-ACS). For the purposes of stratification at randomization, ACS will be defined as hospitalization for anginal pain or discomfort within the previous 24 hours to their hospitalization with any one (or more) of the following criteria:
i. Elevated troponin or creatinine kinase-MB (CK-MB) consistent with myocardial infarction (MI), as reported by local laboratory and measured prior to index PCI ii. Electrocardiographic changes (including transient changes) comprising new or presumably new ST segment depression ≥ 0.1 mV (≥ 1 mm), or ST segment elevation ≥ 0.1 mV (≥ 1 mm) in at least 2 contiguous leads, or new or presumably new Left Bundle Branch Block
- Randomization within 14 days post-PCI. In the case of staged PCI procedures, randomization has to occur within 14 days of the last PCI in the series. Participants may be randomized starting on the day of PCI and anytime during the following 14 days. PCI is defined as an attempt to cross the lesion with a wire with the intention of performing revascularization.
- Post-PCI (post the last PCI for staged procedures) evidence of incomplete revascularization defined as the presence of one or more visually estimated ≥ 50% stenoses in one or more coronary arteries with reference vessel diameter of at least 2.0 mm, whether in the target vessel or in a non-target vessel regardless of the presence or absence of coronary collaterals. In the case of a participant post-coronary artery bypass grafting (CABG), incomplete revascularization is defined as the presence of one or more visually estimated ≥ 50% stenoses in an unbypassed epicardial vessel with a reference diameter of ≥ 2.0 mm, or one or more visually estimated ≥ 50% stenoses in a bypass graft supplying an otherwise unrevascularized myocardial territory.
Clinically stable post-PCI. Participants randomized in-hospital on day of planned discharge or in clinic are considered stable. Participants randomized in-hospital prior to day of planned discharge must meet all of the following criteria:
i. CK-MB < 3 times the upper limit of normal (ULN) at least 3 hours post-PCI, or if ≥ 3 times the ULN with evidence of decreasing CK-MB (decreased by at least 20% from the prior measurement) as reported by local laboratory. If CK-MB is not available, a participant must have evidence of normal or decreasing troponin levels (by at least 20% from the prior measurement) at least 3 hours post-PCI, as reported by local laboratory.
ii. Systolic blood pressure ≥ 90 mm Hg and not receiving pressors or inotropes iii. No current requirement for an intra-aortic balloon pump (IABP) or any left ventricular assist device iv. No current requirement for intravenous (IV) nitroglycerin
- Ability and willingness to comply with all study procedures during the course of the study
- Females of childbearing potential must have a negative pregnancy test at Screening (unless surgically sterile or post-menopausal) and must agree to use highly effective contraception methods from Screening throughout the duration of study treatment and for 14 days following the last dose of study drug.
Exclusion Criteria:
- Any future planned revascularization (including staged procedures) or possible planned revascularization (ie, planned stress test to assess the imminent need for additional revascularization). Future planned stress tests for purposes of monitoring are permitted but strongly discouraged. Participants may be enrolled after the last PCI in the staged series or once a decision is made not to perform a follow up PCI, as long as Randomization occurs within 14 days from the last PCI. If a participant has had a stress test post-PCI and prior to Randomization and no further intervention is planned, the participant may be enrolled within 14 days from the last PCI.
- Unrevascularized left main coronary artery stenosis ≥ 50%. Participants with a history of CABG to the left coronary system will be considered to have a revascularized left main if at least one graft is patent.
Major complication during or after the index PCI (in the case of staged PCI, the last in the series) including:
i. Major bleeding (TIMI Bleeding classification or any bleeding requiring blood transfusion of ≥ 2 units of red blood cells) ii. Coronary perforation requiring treatment iii. Procedural complication requiring surgery (including CABG or peripheral vascular surgery)
- Stroke within 90 days prior to Randomization, or any history of stroke with permanent major neurologic disability (eg, aphasia or significant motor dysfunction)
- Cardiogenic shock within 90 days prior to Randomization (transient decreases in blood pressure without clinical sequelae are not considered to be cardiogenic shock)
- New York Heart Association (NYHA) Class III or IV heart failure
- Severe renal insufficiency as assessed by an estimated glomerular filtration rate < 30 mL/min/1.73m2 using the 4 variable modification of diet in renal disease (MDRD) equation per local laboratory (based on the last available measurement prior to Randomization, collected within 1 month prior to the index PCI [in the case of staged PCI, the last in the series])
- Liver cirrhosis
- Use of Class Ia, Ic, or Class III antiarrhythmics, except for amiodarone
- Current treatment with strong inhibitors of CYP3A
- Current treatment with CYP3A4 inducers or P-gp inducers
- Participants taking > 20 mg simvastatin daily or > 40 mg lovastatin daily who cannot reduce the dose to 20 mg once daily for simvastatin or 40 mg once daily for lovastatin, or who cannot switch to another statin
- Participants taking greater than a total of 1000 mg daily of metformin who cannot reduce the dose to a maximum total of 1000 mg daily (additional anti-diabetic medications may be added as clinically indicated to allow participants to decrease their metformin dose and maintain glycemic control)
- Previous treatment with ranolazine for > 7 consecutive days within 30 days prior to Randomization, or known hypersensitivity or intolerance to ranolazine or to any of the excipients
- Participation in another investigational drug or investigational device study within 30 days prior to Randomization (participation in registries is allowed)
- Women who are pregnant or breast feeding
- Non-coronary artery disease comorbid conditions (eg, advanced malignancy, severe aortic stenosis) which are likely to result in death within 2 years of Randomization
- Any condition that in the opinion of the investigator would preclude compliance with the study protocol
Sites / Locations
- Cardiology, PC
- University of Alabama at Birmingham
- Heart Center Research, LLC
- Scottsdale Healthcare
- Scottsdale Healthcare
- University of California San Diego
- Spectrum Clinical Research Institute, Inc
- Veterans Affairs San Diego Healthcare System
- John Muir Medical Center Concord Campus
- South Denver Cardiology Associates, PC
- Yale University School of Medicine
- Cardiology Associates of Fairfield County, PC
- Washington Hospital Center
- Zasa Clinical Research
- Cardiology Research Associates
- Broward General Medical Center
- University of Florida
- Michigan Heart, PC
- Jacksonville Heart Center
- University of Florida Health Sciences Center-Jacksonville
- East Coast Institute for Research
- Mayo Clinic Jacksonville
- Mount Sinai Medical Center
- Florida Heart Institute
- Cardiovascular Institute of Northwest Florida
- Tallahassee Research Institute
- Pepin Heart Hospital and Dr. Kiran C. Patel Research Institute
- University of Chicago Medical Center
- Gateway Cardiology, PC
- Indiana Heart Physicians, Inc.
- The Indiana Heart Hospital
- Northwest Indiana Cardiovascular Physicians
- Iowa Heart Center
- Saint Joseph Cardiology Associates
- Clinical Trials of America, Inc.
- Clinical Trials of America, Inc.
- Northeast Cardiology Associates
- Baltimore Heart Associates
- Union Memorial Hospital
- Tufts Medical Center
- Saint Elizabeth's Medical Center
- Cape Cod Research Institute
- Oakwood Hospital and Medical Center
- Essentia Health
- Minneapolis Heart Institute
- Saint Cloud Hospital
- Cardiology Associates of North Mississippi
- Gateway Cardiology, PC
- Saint John's Regional Medical Center
- Dartmouth Hitchcock Medical Center
- Holy Name Medical Center
- New York Methodist Hospital
- Buffalo Heart Group
- SJH Cardiology Associates
- Columbia University Medical Center
- Hudson Valley Heart Center
- Stony Brook University Medical Center
- Central New York Cardiology
- Westchester Medical Center
- Buffalo Cardiology and Pulmonary Associates, PC
- Asheville Cardiology Associates
- Mid Carolina Cardiology
- Veterans Affairs Medical Center, Duke University Medical Center
- Carolina Cardiology Associates
- Wake Heart Research
- Ohio Health Research Institute
- Cardiology Associates of Southeast Ohio, Inc.
- Oklahoma City Veterans' Affairs Medical Center
- South Oklahoma Heart Research
- The Heart and Vascular Center
- Central Bucks Cardiology
- Saint Vincent Health Care Center
- Veterans Administration Medical Center
- Pinnacle Health System
- Rhode Island Hospital
- Research Associates of Jackson
- University of Tennessee
- Centennial Heart Cardiovascular Consultants, LLC
- North Texas Healthcare System, Dept. of Veteran's Affairs
- Humble Cardiology Associates
- Gamma Medical Research Inc.
- San Antonio Endovascular and Heart Institute
- Victoria Heart and Vascular Center
- Utah Cardiology, PC
- University of Vermont Medical Center, Fletcher Allen Health Care
- Sentara Cardiovascular Research Institute
- Landesklinikum Sankt Pölten
- Landeskrankenhaus Graz West
- Innsbruck Universitaetsklinik
- Allgemeines Krankenhaus der Stadt Linz
- Medizinische Universität Wien
- Wilhelminenspital der Stadt Wien
- Ziekenhuis Netwerk Antwerpen Middelheim
- Imelda Ziekenhuis
- ZOL Genk, Campus Saint Jan
- Algemeen Ziekenhuis Sint-Jan
- Centre Hospitalier Universitaire Sart Tilman Liège
- Royal Alexandra Hospital
- University of Alberta Hospital
- New Brunswick Heart Centre
- Hamilton Health Sciences, General Site
- Hamilton Health Sciences
- Scarborough Cardiology Research Associates
- Saint Michael's Hospital
- University Health Network
- Centre Hospitalier de l'Universite de Montreal (CHUM)
- Montreal Heart Institute
- Hôpital du Sacré-Coeur de Montréal
- Institut Universitaire de Cardiologie et de Pneumologie de Québec
- Centre Hospitalier Universitaire de Sherbrooke
- Karlovarská krajská nemocnice a.s.
- Krajská nemocnice Liberec a.s.
- Fakultní nemocnice Brno
- Fakultní nemocnice u sv. Anny v Brne
- Fakultní nemocnice Olomouc
- Fakultní nemocnice Královské Vinohrady
- Všeobecná fakultní nemocnice v Praze
- Fakultní Nemocnice v Motole
- Hôpital Bichat-Claude Bernard
- Hôpital Rangueil
- Centre Hospitalier d'Arras
- Centre Hospitalier d'Annecy
- Groupe hospitalier La Pitié Salpêtrière
- Universitätsklinikum Heidelberg
- Kerckhoff-Klinik GmbH
- Asklepios-Kliniken Langen
- Städtische Kliniken Bielefeld gGmbH
- Sankt Johannes Hospital
- Kliniken Maria Hilf GmbH
- Krankenhaus Der Barmherzigen Brüder Trier
- Vivantes Klinikum im Friedrichshain
- Kaplan Medical Center
- HaEmek Medical Center
- Barzilai Medical Center
- Assaf Harofeh Medical Centre
- Rambam Medical Center
- Bnai Zion Medical Center
- Edith Wolfson Medical Center
- Shaare Zedek Medical Center
- Hadassah Ein-Kerem Medical Centre
- Meir Medical Center
- Western Galilee Hospital
- Hillel Yaffe Medical Center
- Tel Aviv Souraski Medical Center
- Sheba Medical Center
- ZIV Medical Center
- Ospedali Riuniti di Bergamo
- Azienda Ospedaliera S. Sebastiano di Caserta
- Azienda Ospedaliero-Universitaria Careggi
- Azienda Ospedaliera Universitaria San Martino
- Fondazione Centro S. Raffaele del Monte Tabor, Ospedale San Raffaele
- Azienda Ospedaliera "Maggiore della Carita" di Novara
- A.R.N.A.S. Civico G. Di Cristina Benfratelli
- Azienda Ospedaliero Universitaria di Parma
- Ospedale Civile SS Annunziata ASL 1
- Catharina Ziekenhuis
- TweeSteden Ziekenhuis
- Academisch Medisch Centrum
- Maasstad Ziekenhuis
- Ziekenhuis Rijnstate Arnhem
- 4th Wojskowy Szpital Kliniczny z Poliklinika, Klinika Kardiologii
- American Heart of Poland S.A.
- American Heart of Poland S.A.
- Szpital Uniwersytecki w Krakowie
- Centralny Szpital Kliniczny Ministerstwa Spraw Wewnetrznych i Administracji w Warszawie
- Instytut Kardiologii
- American Heart of Poland S.A.
- American Heart of Poland S.A.
- American Heart of Poland S.A.
- American Heart of Poland S.A.
- SPZOZ, SPSK nr 7 Slaskiego Uniwersytetu Medycznego w Katowicach, Górnoslaskie Centrum Medyczne
- American Heart of Poland S.A.
- American Heart of Poland S.A.
- SPZOZ, Szpital Wojewódzki we Wloclawku
- Samodzielny Publiczny Szpital Kliniczny nr. 1 im. Przemienienia Panskiego
- Wojewódzki Szpital Zespolony im. Ludwika Rydygiera w Toruniu
- SPZOZ, Samodzielny Publiczny Centralny Szpital Kliniczny w Warszawie
- Altai Regional Cardiological Dispensary
- Regional Clinical Hospital №3
- Ural Institute of Cardiology
- Cardiological Dispensary
- Republic Clinical Hospital № 2
- Research Institute for Complex Issues of Cardiovascular Diseases
- Medical Center "Alliance"
- Regional Clinical Hospital
- National Research Center For Preventive Medicine
- City Clinical Hospital # 23 n.a."Medsantrud"
- City Clinical Hospital #15 named after O.M. Filatov
- University Clinical Hospital #1
- City Clinical Hospital n.a. S.P.Botkin
- City Clinical Hospital #5
- City Clinical Emergency Hospital # 2
- Penza Regional Clinical Hospital n.a. N.N. Burdenko
- Federal Center of Heart, Blood and Endocrinology n.a. V.A.Almazov
- Scientific and Research Institution Of Cardiology
- Volgograd Regional Clinical Cardiological Center
- Hospital Central de Asturias
- Hospital Universitario de Bellvitge
- Complejo Hospitalario Universitario de Vigo, Meixoeiro Hospital
- Hospital General Universitario de Alicante
- Hospital Vall d´Hebrón
- Hospital Clinic I Provincial de Barcelona
- Hospital Clínico San Carlos
- Hospital Universitario La Paz
- Hospital Clínico Universitario Virgen de la Victoria
- Hospital Universitario Marques de Valdecilla
- Hospital Clinico Universitario de Valencia
- Universitetssjukhuset Örebro
- Falu lasarett
- Sahlgrenska Universitetsjukhuset
- Karlstad Central Hospital
- Uppsala University Hospital
- Royal Sussex County Hospital
- The James Cook University Hospital
- Freeman Hospital
- Ashford and Saint Peter's Hospital NHS Trust
- Saint Richards Hospital
- Royal Victoria Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Placebo Comparator
Ranolazine
Placebo