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MAGnesium-based Bioresorbable Scaffold in ST Segment Elevation Myocardial Infarction (MAGSTEMI)

Primary Purpose

Acute Coronary Syndrome, ST Segment Elevation Myocardial Infarction, Stent

Status
Completed
Phase
Phase 3
Locations
Spain
Study Type
Interventional
Intervention
Percutaneous coronary intervention
Sponsored by
Hospital Clinic of Barcelona
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Coronary Syndrome focused on measuring biodegradable stent, STEMI, Magnesium bioresorbable, Vasomotion

Eligibility Criteria

18 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Clinical:

  1. At least 18 years of age.
  2. ST-segment elevation Myocardial Infarction documented in an ambulance or in a Cathlab, with ≥2 mm ST segment elevation in at least two contiguous leads, presenting in the Cathlab <12 hours after the onset of symptoms lasting ≥20 min requiring primary PCI.
  3. Target lesion must be a de-novo lesion located in a native vessel.
  4. The patient accepts Informed Consent
  5. The patient understands and accepts clinical follow-up and angiographic control.

    Angiographic:

  6. Vessel size should match available M-BRS scaffold sizes (≥2.75 mm, and ≤3.7 mm by visual assessment).
  7. Lesion preparation by either manual thrombectomy or pre-dilatation has been successful, with opening of the vessel and TIMI ≥2 and residual stenosis <20%.

Exclusion Criteria:

  1. Pregnancy.
  2. Known intolerance to aspirin, heparin, stainless steel, sirolimus, and contrast material.
  3. Distal vessel occlusion after recanalization
  4. STEMI due to stent/scaffold thrombosis
  5. Severe tortuous, calcified or angulated coronary anatomy of the study vessel that in the opinion of the investigator would result in sub-optimal m-BRS placement.
  6. Fibrinolysis prior to PCI
  7. Known thrombocytopenia (PLT< 100,000/mm3)
  8. Active bleeding or coagulopathy or patients at chronic anticoagulation therapy
  9. Cardiogenic Shock
  10. Significant comorbidities precluding clinical/angiographic FU (as judged by investigators)
  11. Major planned surgery that requires discontinuation of dual antiplatelet therapy.
  12. Diffuse coronary artery disease that will require CABG
  13. Chronic kidney disease with GFR<30 ml/min

Sites / Locations

  • Hospital General de Alicante
  • Hospital Clínic
  • Hospital Sant Pau
  • Hospital Universitari Bellvitge
  • Hospital Vall d'Hebron
  • Hospital San Pedro de Alcántara
  • Hospital Clínico San Carlos
  • Hospital La Princesa
  • Hospital Puerta de Hierro Majadahonda
  • Hospital Ramon y Cajal
  • Hospital Alvaro Cunqueiro

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Magmaris

Orsiro

Arm Description

Percutaneous coronary intervention by means of Magnesium-based sirolimus-eluting bioresorbable scaffold implantation after proper lesion preparation by balloon predilatation and/or manual thrombectomy.

Percutaneous coronary intervention by means of Biodegradable polymer sirolimus-eluting stent implantation after proper lesion preparation by balloon predilatation and/or manual thrombectomy.

Outcomes

Primary Outcome Measures

In-stent/scaffold vasodilatory endothelium independent response
in-stent/scaffold vasodilatory response ≥3% (delta in mean lumen diameter) after nitroglycerin injection

Secondary Outcome Measures

Device success
implantation of the intended device with attainment of <30% residual stenosis of the target lesion and TIMI ≥2
Procedure success
device success and no in-hospital cardiac events: death, repeat MI, TVR or stent/scaffold thrombosis
Device-oriented Composite Endpoint (DOCE)
Combined of cardiac death, Target vessel MI, or clinically-indicated target lesion revascularization
Cardiac death
ARC definition
Target vessel MI
ARC definition
Clinically driven target lesion revascularization
ARC definition-Ischemia driven revascularization
Stent/scaffold thrombosis
ARC definition: definite, probable, possible, acute, subacute, late and very late
Patient oriented endpoint (POCE)
Combined of all-cause death, any repeat myocardial infarction and any revascularization
All-cause death
All-cause death rate
Any repeat myocardial infarction
According to WHO extended definition
Any revascularization
Any repeat intervention in the patient
Target lesion revascularization
ARC definition
Target vessel revascularization
ARC definition
MLD
Minimal lumen diameter by QCA
%DS
percentage diameter stenosis by QCA
Acute gain
MLD post - MLD pre by QCA
Late loss
MLD post - MLD at 1 year follow-up by QCA
Binary restenosis
% of patients with >50% DS at 1 year follow-up by QCA
Lumen area
Mean and minimum lumen area of the stented/scaffolded segment by OCT
Mean lumen volume
mean lumen volume of the stented/scaffolded segment by OCT
% strut malapposition
mean area of strut malapposition by OCT
Tissue Prolapse
presence and % of lumen area occupied by tissue prolapse by OCT
Neointimal hyperplasia
mean intra-stent/scaffold area occupied by neointimal hyperplasia by OCT
Healing index
Index obtained by a combination of % malapposition, % coverage, % tissue prolapse by OCT
Strut coverage
Presence and amount of tissue covering the strut of the stent/scaffold by OCT
RUTTS
Ratio of Uncovered to Total Stent/scaffold Struts Per Cross Section (RUTTS) score of ≤30% of the target stent/scaffold as determined by OCT pullback
in-stent/in-scaffold endothelium-dependent vasomotion
% change in mean luminal dimeter on the treated segment after acetylcholine infusion

Full Information

First Posted
July 24, 2017
Last Updated
April 15, 2020
Sponsor
Hospital Clinic of Barcelona
Collaborators
Spanish Society of Cardiology
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1. Study Identification

Unique Protocol Identification Number
NCT03234348
Brief Title
MAGnesium-based Bioresorbable Scaffold in ST Segment Elevation Myocardial Infarction
Acronym
MAGSTEMI
Official Title
MAGnesium-based Bioresorbable Scaffold and Vasomotor Function in Patients With Acute ST Segment Elevation Myocardial Infarction
Study Type
Interventional

2. Study Status

Record Verification Date
April 2020
Overall Recruitment Status
Completed
Study Start Date
July 1, 2017 (Actual)
Primary Completion Date
June 30, 2019 (Actual)
Study Completion Date
October 31, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Hospital Clinic of Barcelona
Collaborators
Spanish Society of Cardiology

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a prospective, randomized, active control, single-blind, non-inferiority, multicenter clinical trial. 148 subjects will be registered at up to 10 Spanish sites. Subjects will be followed for 5 years. All eligible patients (STEMI < 12 hours from onset of chest pain) will be randomized to Biotronik MAGMARISTM Sirolimus Eluting Bioresorbable Vascular Scaffold System (M-BRS) or Biotronik ORSIRO Sirolimus Eluting Coronary Stent System Endothelium-independent vasomotor response (NTG injection) will be analyzed at 12 months angiographic follow-up (Primary endpoint). In a subgroup of 40 patients Optical Coherence Tomography will be performed after the procedure and at 12 months follow-up. Angiographic (QCA pre- and post-procedure and at 12 months follow-up), OCT data (at 12 months follow-up) will be analyzed off-line by an independent core lab.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Coronary Syndrome, ST Segment Elevation Myocardial Infarction, Stent
Keywords
biodegradable stent, STEMI, Magnesium bioresorbable, Vasomotion

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
Patients will be randomised to one of two groups: MAGMARIS stent arm or ORSIRO stent arm in the ratio of 1:1
Masking
ParticipantOutcomes Assessor
Masking Description
Neither the participant ot the outcomes assessor will be aware of the treatment received. The patient will be blinded until the primary endpoint is reached (1 year follow-up).
Allocation
Randomized
Enrollment
151 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Magmaris
Arm Type
Experimental
Arm Description
Percutaneous coronary intervention by means of Magnesium-based sirolimus-eluting bioresorbable scaffold implantation after proper lesion preparation by balloon predilatation and/or manual thrombectomy.
Arm Title
Orsiro
Arm Type
Placebo Comparator
Arm Description
Percutaneous coronary intervention by means of Biodegradable polymer sirolimus-eluting stent implantation after proper lesion preparation by balloon predilatation and/or manual thrombectomy.
Intervention Type
Device
Intervention Name(s)
Percutaneous coronary intervention
Other Intervention Name(s)
stent implantation
Intervention Description
PCI + stent implantation
Primary Outcome Measure Information:
Title
In-stent/scaffold vasodilatory endothelium independent response
Description
in-stent/scaffold vasodilatory response ≥3% (delta in mean lumen diameter) after nitroglycerin injection
Time Frame
12 months follow-up
Secondary Outcome Measure Information:
Title
Device success
Description
implantation of the intended device with attainment of <30% residual stenosis of the target lesion and TIMI ≥2
Time Frame
Immediate after the procedure
Title
Procedure success
Description
device success and no in-hospital cardiac events: death, repeat MI, TVR or stent/scaffold thrombosis
Time Frame
Up to 7 days
Title
Device-oriented Composite Endpoint (DOCE)
Description
Combined of cardiac death, Target vessel MI, or clinically-indicated target lesion revascularization
Time Frame
1, 6 months, 1,2,3,4,5 years
Title
Cardiac death
Description
ARC definition
Time Frame
1, 6 months, 1,2,3,4,5 years
Title
Target vessel MI
Description
ARC definition
Time Frame
1, 6 months, 1,2,3,4,5 years
Title
Clinically driven target lesion revascularization
Description
ARC definition-Ischemia driven revascularization
Time Frame
1, 6 months, 1,2,3,4,5 years
Title
Stent/scaffold thrombosis
Description
ARC definition: definite, probable, possible, acute, subacute, late and very late
Time Frame
1, 6 months, 1,2,3,4,5 years
Title
Patient oriented endpoint (POCE)
Description
Combined of all-cause death, any repeat myocardial infarction and any revascularization
Time Frame
1, 6 months, 1,2,3,4,5 years
Title
All-cause death
Description
All-cause death rate
Time Frame
1, 6 months, 1,2,3,4,5 years
Title
Any repeat myocardial infarction
Description
According to WHO extended definition
Time Frame
1, 6 months, 1,2,3,4,5 years
Title
Any revascularization
Description
Any repeat intervention in the patient
Time Frame
1, 6 months, 1,2,3,4,5 years
Title
Target lesion revascularization
Description
ARC definition
Time Frame
1, 6 months, 1,2,3,4,5 years
Title
Target vessel revascularization
Description
ARC definition
Time Frame
1, 6 months, 1,2,3,4,5 years
Title
MLD
Description
Minimal lumen diameter by QCA
Time Frame
Baseline and 1 year follow-up
Title
%DS
Description
percentage diameter stenosis by QCA
Time Frame
Baseline and 1 year follow-up
Title
Acute gain
Description
MLD post - MLD pre by QCA
Time Frame
Baseline
Title
Late loss
Description
MLD post - MLD at 1 year follow-up by QCA
Time Frame
1 year
Title
Binary restenosis
Description
% of patients with >50% DS at 1 year follow-up by QCA
Time Frame
1 year
Title
Lumen area
Description
Mean and minimum lumen area of the stented/scaffolded segment by OCT
Time Frame
1 year follow-up
Title
Mean lumen volume
Description
mean lumen volume of the stented/scaffolded segment by OCT
Time Frame
1 year follow-up
Title
% strut malapposition
Description
mean area of strut malapposition by OCT
Time Frame
1 year follow-up
Title
Tissue Prolapse
Description
presence and % of lumen area occupied by tissue prolapse by OCT
Time Frame
1 year follow-up
Title
Neointimal hyperplasia
Description
mean intra-stent/scaffold area occupied by neointimal hyperplasia by OCT
Time Frame
1 year follow-up
Title
Healing index
Description
Index obtained by a combination of % malapposition, % coverage, % tissue prolapse by OCT
Time Frame
1 year follow-up
Title
Strut coverage
Description
Presence and amount of tissue covering the strut of the stent/scaffold by OCT
Time Frame
1 year follow-up
Title
RUTTS
Description
Ratio of Uncovered to Total Stent/scaffold Struts Per Cross Section (RUTTS) score of ≤30% of the target stent/scaffold as determined by OCT pullback
Time Frame
1 year follow-up
Title
in-stent/in-scaffold endothelium-dependent vasomotion
Description
% change in mean luminal dimeter on the treated segment after acetylcholine infusion
Time Frame
at 12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Clinical: At least 18 years of age. ST-segment elevation Myocardial Infarction documented in an ambulance or in a Cathlab, with ≥2 mm ST segment elevation in at least two contiguous leads, presenting in the Cathlab <12 hours after the onset of symptoms lasting ≥20 min requiring primary PCI. Target lesion must be a de-novo lesion located in a native vessel. The patient accepts Informed Consent The patient understands and accepts clinical follow-up and angiographic control. Angiographic: Vessel size should match available M-BRS scaffold sizes (≥2.75 mm, and ≤3.7 mm by visual assessment). Lesion preparation by either manual thrombectomy or pre-dilatation has been successful, with opening of the vessel and TIMI ≥2 and residual stenosis <20%. Exclusion Criteria: Pregnancy. Known intolerance to aspirin, heparin, stainless steel, sirolimus, and contrast material. Distal vessel occlusion after recanalization STEMI due to stent/scaffold thrombosis Severe tortuous, calcified or angulated coronary anatomy of the study vessel that in the opinion of the investigator would result in sub-optimal m-BRS placement. Fibrinolysis prior to PCI Known thrombocytopenia (PLT< 100,000/mm3) Active bleeding or coagulopathy or patients at chronic anticoagulation therapy Cardiogenic Shock Significant comorbidities precluding clinical/angiographic FU (as judged by investigators) Major planned surgery that requires discontinuation of dual antiplatelet therapy. Diffuse coronary artery disease that will require CABG Chronic kidney disease with GFR<30 ml/min
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Manel Sabaté, MD
Organizational Affiliation
Hospital Clinic of Barcelona
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hospital General de Alicante
City
Alicante
Country
Spain
Facility Name
Hospital Clínic
City
Barcelona
ZIP/Postal Code
08036
Country
Spain
Facility Name
Hospital Sant Pau
City
Barcelona
Country
Spain
Facility Name
Hospital Universitari Bellvitge
City
Barcelona
Country
Spain
Facility Name
Hospital Vall d'Hebron
City
Barcelona
Country
Spain
Facility Name
Hospital San Pedro de Alcántara
City
Cáceres
Country
Spain
Facility Name
Hospital Clínico San Carlos
City
Madrid
Country
Spain
Facility Name
Hospital La Princesa
City
Madrid
Country
Spain
Facility Name
Hospital Puerta de Hierro Majadahonda
City
Madrid
Country
Spain
Facility Name
Hospital Ramon y Cajal
City
Madrid
Country
Spain
Facility Name
Hospital Alvaro Cunqueiro
City
Vigo
Country
Spain

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Data on primary/secondary outcomes on individual basis may be shared with other researchers once main report as been published and review and approval of the research proposal by the steering committee of the Magstemi Trial
IPD Sharing Time Frame
Data on primary/secondary outcomes on individual basis may be shared with other researchers once main report as been published and review and approval of the research proposal by the steering committee of the Magstemi Trial
Citations:
PubMed Identifier
30196572
Citation
Brugaletta S, Cequier A, Alfonso F, Iniguez A, Romani S, Serra A, Salinas P, Goicolea J, Bordes P, Del Blanco BG, Hernandez-Antolin R, Pernigotti A, Gomez-Lara J, Sabate M. MAGnesium-based bioresorbable scaffold and vasomotor function in patients with acute ST segment elevation myocardial infarction: The MAGSTEMI trial: Rationale and design. Catheter Cardiovasc Interv. 2019 Jan 1;93(1):64-70. doi: 10.1002/ccd.27825. Epub 2018 Sep 9.
Results Reference
background
PubMed Identifier
31553204
Citation
Sabate M, Alfonso F, Cequier A, Romani S, Bordes P, Serra A, Iniguez A, Salinas P, Garcia Del Blanco B, Goicolea J, Hernandez-Antolin R, Cuesta J, Gomez-Hospital JA, Ortega-Paz L, Gomez-Lara J, Brugaletta S. Magnesium-Based Resorbable Scaffold Versus Permanent Metallic Sirolimus-Eluting Stent in Patients With ST-Segment Elevation Myocardial Infarction: The MAGSTEMI Randomized Clinical Trial. Circulation. 2019 Dec 3;140(23):1904-1916. doi: 10.1161/CIRCULATIONAHA.119.043467. Epub 2019 Sep 25.
Results Reference
result
PubMed Identifier
32310130
Citation
Gomez-Lara J, Ortega-Paz L, Brugaletta S, Cuesta J, Romani S, Serra A, Salinas P, Garcia Del Blanco B, Goicolea J, Hernandez-Antolin R, Antuna P, Romaguera R, Regueiro A, Rivero F, Cequier A, Alfonso F, Gomez-Hospital JA, Sabate M; Collaborators. Bioresorbable scaffolds versus permanent sirolimus-eluting stents in patients with ST-segment elevation myocardial infarction: vascular healing outcomes from the MAGSTEMI trial. EuroIntervention. 2020 Dec 4;16(11):e913-e921. doi: 10.4244/EIJ-D-20-00198.
Results Reference
derived

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MAGnesium-based Bioresorbable Scaffold in ST Segment Elevation Myocardial Infarction

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