Prognostic Value of Precision Medicine in Patients With MINOCA (PROMISE Trial). (PROMISE)
Myocardial Infarction With Non-Obstructive Coronary Arteries
About this trial
This is an interventional treatment trial for Myocardial Infarction With Non-Obstructive Coronary Arteries focused on measuring MINOCA, coronary spasm, OCT
Eligibility Criteria
Inclusion Criteria:
- Ability to give informed consent to the study
- Age > 18y
MINOCA diagnosis, defined as:
- Acute myocardial infarction (based on Fourth Universal Definition of Myocardial Infarction Criteria):
- Evidence of non-obstructive coronary artery disease on angiography (i.e., no coronary artery stenosis >50%) in any major epicardial vessel.
- No specific alternate diagnosis for the clinical presentation (i.e. non-ischemic causes of myocardial injury such as sepsis, pulmonary embolism, and myocarditis).
Exclusion Criteria:
- Inability or limited capacity to give informed consent to the study
- Age < 18 y
- Pregnant and breast-feeding women or patients considering becoming pregnant during the study period will be excluded. For women of childbearing potential, the use of a highly effective contraceptive measure is required in order to be included in the study. "Highly effective contraceptive" is defined in accordance with the recommendations of the Clinical Trial Facilitation Group as a contraceptive measure with a failure rate of less than 1% per year (https://www.hma.eu/fileadmin/dateien/Human_Medicines/01-About_HMA/Working_Groups/CTFG/2020_09_HMA_CTFG_Contraception_guidance_Version_1.1_updated.pdf).
- Alternate diagnosis for the clinical presentation (i.e. non-ischemic causes of myocardial injury such as sepsis, pulmonary embolism, valve disease, hypertrophic cardiomyopathy and myocarditis). Also patients presenting with Takotsubo syndrome will be excluded.
- Contraindication to contrast-enhanced CMR, eg, severe renal dysfunction (glomerular filtration rate <30 mL/min), non-CMR-compatible pacemaker or defibrillator.
- Contraindication to drugs administrated: e.g a history of hypersensitivity to drugs administrated or its excipients, significant renal and/or hepatic disease.
- Patients with comorbidities having an expected survival <1-year will be excluded.
Sites / Locations
- Centro Cardiologico MonzinoRecruiting
- Fondazione Policlinico Universitario A. Gemelli IRCCSRecruiting
- IRCCS Policlinico San Donato
Arms of the Study
Arm 1
Arm 2
Active Comparator
Other
"Precision medicine approach"
"Standard approach"
Comprehensive diagnostic work-up with: Coronary angiography and ventriculography in all patients OCT at the time of coronary angiography in the cath-lab. Acetylcholine provocative test (to assess the presence of coronary vasospasm) at the time of coronary angiography in the cath-lab. TE-Echo and/or CE-Echo (if distal/microvascular embolization is suspected) Blood sampling for circulating biomarkers and miRNA expression profile Trans-thoracic echocardiography in all patients during the index hospitalization CMR in all cases during the index hospitalization. Targeted pharmacological treatment specific for the underlying cause: DAPT ± stent implantation (if required), statins, beta-blockers, ACEi/ARB (in case of evidence of plaque rupture/erosion) CCB and/or nitrates (in case of documentation of coronary vasospasm) Anticoagulation (in case of coronary embolism).
Routine diagnostic work-up with: Coronary angiography and ventriculography Transthoracic echocardiography in all patients during the index hospitalization CMR with contrast media only if clinically indicated (i.e. to exclude myocarditis or takotsubo syndrome) Standard medical treatment with: DAPT in all patients Beta-blockers (if indicated by the clinical context, i.e. documentation of left ventricular ejection fraction <50%, tachycardia). High intensity statins in all patients ACEi/ARB (if clinically indicated).