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The PIONEER-IV Study is Comparing Clinical Outcomes Between Angiography-derived Physiology Guidance to Usual Care in an All-comers PCI Population With Unrestrictive Use of the HT Supreme Sirolimus-eluting Stent (PIONEER-IV)

Primary Purpose

Coronary Artery Disease

Status
Recruiting
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Angiography-derived physiology guidance/Local routine diagnostic procedure (LRDP) and usual care
Sponsored by
National University of Ireland, Galway, Ireland
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Coronary Artery Disease focused on measuring coronary artery disease, ischemia, quantitative flow ratio (QFR), P2Y12 monotherapy, drug-eluting stent, physiology guidance

Eligibility Criteria

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

Inclusion Criteria:

  • Patient has chronic stable angina, acute coronary syndromes or silent ischemia;
  • Presence of one or more coronary artery stenoses of ≥50% (by visual assessment) in a native coronary artery (with or without prior stent/other device treatment) or in a saphenous venous or arterial bypass conduit suitable for coronary stent implantation;
  • The vessel should have a reference vessel diameter of at least 2.25 mm by visual assessment (no limitation on the number of treated lesions, vessels, or lesion length);
  • Patient has been informed of the nature of the study and agrees to its provisions and has provided written informed consent as approved by the Ethical Committee and is willing to comply with all protocol-required (follow-up) evaluations.

Exclusion Criteria:

  1. Patient is a woman who is pregnant or nursing (a pregnancy test must be performed within 7 days prior to the index procedure in women of child-bearing potential according to local practice);
  2. Known intolerance to cobalt chromium, and medications such as sirolimus, aspirin, heparin, bivalirudin or P2Y12 inhibitors;
  3. Planned major elective surgery requiring discontinuation of (dual)anti platelet therapy (DAPT) within 12 months of procedure;
  4. Concurrent medical condition with a life expectancy of less than 3 years;
  5. Currently participating in another trial and not yet at its primary endpoint;
  6. Active pathological bleeding;
  7. History of intracranial haemorrhage.

Sites / Locations

  • ASZ AalstRecruiting
  • OLVZ AalstRecruiting
  • ImeldaziekenhuisRecruiting
  • Jessa Hospital HasseltRecruiting
  • University Hospital GalwayRecruiting
  • OLVG AmsterdamRecruiting
  • Medisch Spectrum Twente, Thoraxcentrum, EndchedeRecruiting
  • UMC GroningenRecruiting
  • Medisch Centrum LeeuwardenRecruiting
  • Maasstad Hospital
  • Lucas Augusti Hospital
  • Hospital Clínico San Carlos
  • Hospital Álvaro Cunqueiro Vigo.
  • Barts Health NHS Trust, London

Arms of the Study

Arm 1

Arm 2

Arm Type

Other

Other

Arm Label

Angiography-derived Physiology Guidance (Quantitative Flow Ratio, QFR)

Local routine diagnostic procedure (LRDP) and usual care

Arm Description

Outcomes

Primary Outcome Measures

Patient-oriented Composite Endpoint (PoCE)
PoCE is a composite clinical endpoint of: all-cause death; any stroke, Modified Rankin scale, (MRS ≥1); any myocardial infarction; any clinically and physiologically driven revascularization.

Secondary Outcome Measures

Vessel-oriented composite endpoints (VoCE)
VoCE is a composite clinical endpoint of: Vessel-related cardiovascular Death Target-vessel related MI Clinically and physiologically-oriented Target vessel revascularization
Device-oriented composite endpoint (DoCE)
DoCE is a composite endpoint of: Cardiovascular Death Target-vessel related MI Clinically and physiologically-oriented Target lesion revascularization
Myocardial Infarction (MI)
Peri-procedure Myocardial Infarction according to 4th universal definition
Device Success Rate
according to the statement from European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the European Society of Cardiology (ESC)
Stent Thrombosis
Definite, Probable, Definite or Probable
Target Vessel Failure (TVF)
TVF is a composite of: Cardiovascular Death Target-vessel related MI Clinically and physiologically-oriented Target vessel revascularization
Bleeding
Bleeding according to Bleeding Academic Research Consortium (BARC) (BARC 2, 3 and 5) classification

Full Information

First Posted
June 3, 2021
Last Updated
July 27, 2022
Sponsor
National University of Ireland, Galway, Ireland
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1. Study Identification

Unique Protocol Identification Number
NCT04923191
Brief Title
The PIONEER-IV Study is Comparing Clinical Outcomes Between Angiography-derived Physiology Guidance to Usual Care in an All-comers PCI Population With Unrestrictive Use of the HT Supreme Sirolimus-eluting Stent
Acronym
PIONEER-IV
Official Title
Non-inferiority of Angiography-derived Physiology Guidance Versus Usual Care in an All-comers PCI Population Treated With Unrestricted Use of the Healing-Targeted Supreme (HT Supreme) Drug-eluting Stent and P2Y12 Inhibitor Monotherapy After 1-month of Dual-antiplatelet Therapy
Study Type
Interventional

2. Study Status

Record Verification Date
July 2022
Overall Recruitment Status
Recruiting
Study Start Date
November 12, 2021 (Actual)
Primary Completion Date
January 2023 (Anticipated)
Study Completion Date
January 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
National University of Ireland, Galway, Ireland

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
PIONEER-IV is a prospective, single-blind (patient), randomized, 1:1, controlled, multi-center study comparing clinical outcomes between angiography-derived physiology guidance to LRDP and usual care in an all-comers patient population (including patients with high bleeding risk, HBR) undergoing PCI with unrestrictive use of the HT Supreme sirolimus-eluting stent. Patients will be randomized to either angio-based physiology guidance (QFR) or local routine diagnostic procedure (LRDP) and usual care. Patients will be treated with 1-year P2Y12 inhibitor monotherapy after 1-month of dual-antiplatelet therapy in approximately 2540 (2*1270) patients. All patients (both cohorts) must receive dual anti-platelet therapy, being aspirin (ASA) and ticagrelor for 1 month, followed by 11 months of ticagrelor only (i.e. monotherapy). At 1 year, ticagrelor monotherapy is replaced by aspirin monotherapy or left to the discretion of the operator.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Coronary Artery Disease
Keywords
coronary artery disease, ischemia, quantitative flow ratio (QFR), P2Y12 monotherapy, drug-eluting stent, physiology guidance

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
2540 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Angiography-derived Physiology Guidance (Quantitative Flow Ratio, QFR)
Arm Type
Other
Arm Title
Local routine diagnostic procedure (LRDP) and usual care
Arm Type
Other
Intervention Type
Other
Intervention Name(s)
Angiography-derived physiology guidance/Local routine diagnostic procedure (LRDP) and usual care
Intervention Description
percutaneous coronary intervention
Primary Outcome Measure Information:
Title
Patient-oriented Composite Endpoint (PoCE)
Description
PoCE is a composite clinical endpoint of: all-cause death; any stroke, Modified Rankin scale, (MRS ≥1); any myocardial infarction; any clinically and physiologically driven revascularization.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Vessel-oriented composite endpoints (VoCE)
Description
VoCE is a composite clinical endpoint of: Vessel-related cardiovascular Death Target-vessel related MI Clinically and physiologically-oriented Target vessel revascularization
Time Frame
12, 24 and 36 months
Title
Device-oriented composite endpoint (DoCE)
Description
DoCE is a composite endpoint of: Cardiovascular Death Target-vessel related MI Clinically and physiologically-oriented Target lesion revascularization
Time Frame
12, 24 and 36 months
Title
Myocardial Infarction (MI)
Description
Peri-procedure Myocardial Infarction according to 4th universal definition
Time Frame
48 hours post-procedure
Title
Device Success Rate
Description
according to the statement from European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the European Society of Cardiology (ESC)
Time Frame
index procedure
Title
Stent Thrombosis
Description
Definite, Probable, Definite or Probable
Time Frame
Procedure, 12, 24 and 36 months
Title
Target Vessel Failure (TVF)
Description
TVF is a composite of: Cardiovascular Death Target-vessel related MI Clinically and physiologically-oriented Target vessel revascularization
Time Frame
12, 24 and 36 months
Title
Bleeding
Description
Bleeding according to Bleeding Academic Research Consortium (BARC) (BARC 2, 3 and 5) classification
Time Frame
12, 24 and 36 months follow-up

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient has chronic stable angina, acute coronary syndromes or silent ischemia; Presence of one or more coronary artery stenoses of ≥50% (by visual assessment) in a native coronary artery (with or without prior stent/other device treatment) or in a saphenous venous or arterial bypass conduit suitable for coronary stent implantation; The vessel should have a reference vessel diameter of at least 2.25 mm by visual assessment (no limitation on the number of treated lesions, vessels, or lesion length); Patient has been informed of the nature of the study and agrees to its provisions and has provided written informed consent as approved by the Ethical Committee and is willing to comply with all protocol-required (follow-up) evaluations. Exclusion Criteria: Patient is a woman who is pregnant or nursing (a pregnancy test must be performed within 7 days prior to the index procedure in women of child-bearing potential according to local practice); Known intolerance to cobalt chromium, and medications such as sirolimus, aspirin, heparin, bivalirudin or P2Y12 inhibitors; Planned major elective surgery requiring discontinuation of (dual)anti platelet therapy (DAPT) within 12 months of procedure; Concurrent medical condition with a life expectancy of less than 3 years; Currently participating in another trial and not yet at its primary endpoint; Active pathological bleeding; History of intracranial haemorrhage.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Patrick W Serruys, MD
Phone
+31622924061
Email
Patrick.Serruys@Nuigalway.ie
First Name & Middle Initial & Last Name or Official Title & Degree
Yoshinobu Onuma, MD
Phone
+353852882318
Email
Yoshinobu.Onuma@Nuigalway.ie
Facility Information:
Facility Name
ASZ Aalst
City
Aalst
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Liesbeth Rosseel, MD
Facility Name
OLVZ Aalst
City
Aalst
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Emanuele Barbato, MD PhD
Facility Name
Imeldaziekenhuis
City
Bonheiden
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Luc Janssens, MD
Facility Name
Jessa Hospital Hasselt
City
Hasselt
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Edouard Benit
Facility Name
University Hospital Galway
City
Galway
Country
Ireland
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Faisal Sharif, MD
Facility Name
OLVG Amsterdam
City
Amsterdam
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Giovanni Amoroso
Facility Name
Medisch Spectrum Twente, Thoraxcentrum, Endchede
City
Endchede
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Clemens Von Birgelen
Facility Name
UMC Groningen
City
Groningen
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Joanna Wykrzykowska, MD PhD
Facility Name
Medisch Centrum Leeuwarden
City
Leeuwarden
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sjoerd Hofma
Facility Name
Maasstad Hospital
City
Rotterdam
Country
Netherlands
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Peter Smits, MD
Facility Name
Lucas Augusti Hospital
City
Lugo
Country
Spain
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Raymundo Ocaranza
Facility Name
Hospital Clínico San Carlos
City
Madrid
Country
Spain
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Javier Escaned, MD
Facility Name
Hospital Álvaro Cunqueiro Vigo.
City
Vigo
Country
Spain
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Victor Alonso Jimenez Diaz
Facility Name
Barts Health NHS Trust, London
City
London
Country
United Kingdom
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Andreas Baumbach, MD

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
34990582
Citation
Hara H, Serruys PW, O'Leary N, Gao C, Murray A, Breslin E, Garg S, Bureau C, Reiber JH, Barbato E, Aminian A, Janssens L, Rosseel L, Benit E, Campo G, Guiducci V, Casella G, Santarelli A, Franze A, Diaz VAJ, Iniguez A, Brugaletta S, Sabate M, Amat-Santos IJ, Amoroso G, Wykrzykowska J, von Birgelen C, Somi S, Liu T, Hofma SH, Curzen N, Trillo R, Ocaranza R, Mathur A, Smits PC, Escaned J, Baumbach A, Wijns W, Sharif F, Onuma Y; PIONEER IV trial investigator. Angiography-derived physiology guidance vs usual care in an All-comers PCI population treated with the healing-targeted supreme stent and Ticagrelor monotherapy: PIONEER IV trial design. Am Heart J. 2022 Apr;246:32-43. doi: 10.1016/j.ahj.2021.12.018. Epub 2022 Jan 3.
Results Reference
derived

Learn more about this trial

The PIONEER-IV Study is Comparing Clinical Outcomes Between Angiography-derived Physiology Guidance to Usual Care in an All-comers PCI Population With Unrestrictive Use of the HT Supreme Sirolimus-eluting Stent

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