A Study to Evaluate the Safety and Efficacy of PiCSO in Anterior STEMI Patients (PiCSO-AMI-II)
Primary Purpose
STEMI - ST Elevation Myocardial Infarction, Anterior Wall Myocardial Infarction
Status
Withdrawn
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
PiCSO Impulse System
Sponsored by
About this trial
This is an interventional treatment trial for STEMI - ST Elevation Myocardial Infarction focused on measuring PiCSO, PiCSO Impulse System
Eligibility Criteria
Inclusion Criteria:
- Age ≥18 years old
- Culprit lesion in proximal or mid left anterior descending artery (LAD)
- Pre-PCI TIMI flow 0, 1 or 2
- Symptoms onset time consistent with myocardial ischemia (e.g. persistent chest pain, shortness of breath, nausea/vomiting, fatigue, palpitations or syncope) ≤ 12 h
- Electrocardiogram (ECG) evidence of acute anterior myocardial infarction with ST-elevation ≥ 2 mm (0.2 mV) in 2 or more contiguous anterior precordial ECG leads (one of which should be V2, V3, or V4) in men or ≥ 1.5 mm (0.15 mV) in women
- Emergent PCI will be performed according to national and local hospital guidelines
- Consent per approved national IRB/EC specific requirements prior to the procedure.
Exclusion Criteria:
- Patient transferred from an outside hospital where invasive coronary procedure was attempted (including diagnostic catheterization)
- Implants or foreign bodies in the coronary sinus
- Left main disease >= 50%
- Need for treatment of any vessel other than the LAD (or its branches) during the index procedure or before the 5 ± 2 days study CMR.
- Known allergy to polyurethanes, polyethylene terephthalate (PET) or stainless steel, both heparin and bivalirudin, or all of clopidogrel, ticagrelor or prasugrel that cannot be adequately pre-medicated
- Known pregnancy or breastfeeding
- Known large pericardial effusion or cardiac tamponade
- Known hemodynamically relevant left to right and right to left shunt
- Known previous myocardial infraction (MI)
- Previous coronary artery bypass graft (CABG)
- Known neurologic abnormality such as tumor or arteriovenous (AV) malformation, history of stroke within 6 months, any prior intracranial bleed or any permanent neurologic defect
- History of bleeding diathesis or known coagulopathy (including heparin-induced thrombocytopenia), any recent genitourinary (GU) or gastrointestinal (GI) bleed (within 3 months)
- Administration of fibrinolytic therapy within 24 hours prior to enrollment
- Cardiogenic shock (systolic blood pressure (SBP) < 90 mmHg), need for mechanical circulatory support, intravenous pressor or pre-randomization intubation
- Patients with cardio-pulmonary resuscitated (CPR) cardiac arrest for more than 5 min or whom baseline neurologic status is not present
- Patient not suitable for femoral vein access
- Contraindication to cardiac magnetic resonance imaging CMR (e.g. claustrophobia, foreign body implants incompatible with CMR, gadolinium intolerance)
- Active participation in another drug or device investigational study that has not reached its primary endpoint
- Known severe kidney disease (eGFR <=30 mL/min/1.73 m2 by MDRD formula) or on hemodialysis
- Chronic obstructive pulmonary disease (COPD) with home oxygen therapy or on chronic steroid therapy
- Unconscious on presentation
- Patients under judicial protection, legal guardianship or curatorship
- Subject has other medical illness (e.g., cancer, dementia) or known history of substance abuse (alcohol, cocaine, heroin, etc.) that may cause non-compliance with the protocol, confound the data interpretation, or is associated with limited life expectancy of less than 1 year
- Patients with definite or probable COVID-19 diagnosis > 4 weeks prior to the current MI unless they had returned to their baseline state of health after recovery from the COVID-19 illness
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm Type
No Intervention
Experimental
Arm Label
Control
PiCSO
Arm Description
This is the actual control group receiving conventional therapy, ie. percutaneous coronary intervention.
This arm will be treated with Pressure controlled intermittent Coronary Sinus Occlusion (PiCSO) in addition to conventional therapy (percutaneous coronary intervention).
Outcomes
Primary Outcome Measures
12% performance goal rate of PiCSO device or PiCSO procedure related adverse events reported through 30 days
Primary safety endpoint is based on a 12% performance goal rate of PiCSO device or PiCSO procedure related adverse events reported through 30 days post treatment in patients randomized to PiCSO Group in which the PiCSO treatment was delivered or attempted to be delivered. These events will consist of the composite of:
Femoral venous access site complications:
Major bleed (BARC 3-5)
Infections requiring systemic (oral or intravenous) antibiotic treatment
Any femoral access site-related events requiring surgery
Coronary sinus dissection requiring percutaneous intervention or surgery
Pericardial effusion or tamponade requiring percutaneous intervention or surgery
Embolization or Thrombosis
Stroke
Difference in myocardial infarct size
Difference in myocardial infarct size (extent of myocardial necrosis quantified by delayed gadolinium enhancement presented as a percentage of left ventricular (LV) mass) between the PiCSO Group and the Control Group, assessed by CMR at 5±2 days post index PCI.
Secondary Outcome Measures
Major Adverse Cardiac Event (MACE) at 30 days as well as 1, 2 and 3 years post index PCI
MACE at 30 days as well as 1, 2 and 3 years post index PCI
Cardiovascular death
Cardiovascular hospitalization
Heart failure (HF) hospitalization
New onset or worsening HF
Individual components of the MACE
Individual components of the MACE to be evaluated at 30 days as well as 6 months and 1, 2 and 3 years post index PCI
Classification of all-cause death
Classification of all-cause death at 30 days as well as 6 months and 1, 2 and 3 years post index PCI into the following categories:
Cardiac cause of death
Non-cardiac cause of death
Death of Undetermined Cause
Time to death and heart failure hospitalization
The hierarchical composite of time to death within 1 year, time to heart failure hospitalization within one 1-year and infarct size at assessed by CMR at 5±2 days post index PCI.
Myocardial infarct size (% of LV mass) assessed by CMR at 6 months post index PCI
Myocardial infarct size (% of LV mass) assessed by CMR at 6 months post index PCI
Occurrence and extent of microvascular obstruction and hemorrhage
Occurrence and extent of microvascular obstruction (MVO, % of LV mass) and hemorrhage assessed by CMR at 5 days post index PCI
Myocardial function (LVEF, LVESV, LVEDV)
Myocardial function (Left ventricular ejection fraction (LVEF), Left ventricular end-diastolic volume (LVEDV) and Left ventricular end-systolic volume (LVESV)) assessed by CMR at 5 days and 6 months post index PCI
Myocardial Salvage Index and myocardial infarct size
Myocardial Salvage Index at 5 days and 6 months post index PCI (derived from Area at Risk (AAR) assessed by CMR at 5 days and myocardial infarct size (% of LV mass) assessed by CMR at 5 days or 6 months, respectively)
ST-segment resolution
ST-segment resolution at 60-90 minutes post flow restoration
Device success and procedural success rate
Device success and procedural success rate presented as % of subjects
Changes in quality of life
Changes in quality of life measured by EQ-5D at 5 days, 6 months and 1, 2, 3 years post index PCI
Utilization of health resources
Assess health economics by collecting the utilization of health resources throughout the study duration
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT05497011
Brief Title
A Study to Evaluate the Safety and Efficacy of PiCSO in Anterior STEMI Patients
Acronym
PiCSO-AMI-II
Official Title
A Randomized Controlled Study to Evaluate the Safety and Efficacy of Pressure-controlled Intermittent Coronary Sinus Occlusion (PiCSO) in Anterior STEMI Patients With TIMI 0-2 at Presentation.
Study Type
Interventional
2. Study Status
Record Verification Date
March 2023
Overall Recruitment Status
Withdrawn
Why Stopped
Study terminated due to lack of financing
Study Start Date
March 30, 2023 (Anticipated)
Primary Completion Date
July 31, 2025 (Anticipated)
Study Completion Date
June 30, 2028 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Miracor Medical SA
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Device Product Not Approved or Cleared by U.S. FDA
Yes
5. Study Description
Brief Summary
The objective of this study is to assess the safety and efficacy of Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO) as adjunct to percutaneous coronary intervention (PCI) compared to PCI in the setting of acute anterior ST-segment elevation myocardial infarction (STEMI).
Detailed Description
This is a multicenter, randomized (2 PiCSO :1 Control), controlled, pivotal study to evaluate safety and feasibility of Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO) therapy in patients with acute anterior ST-segment elevation myocardial infarction (STEMI), presenting with thrombolysis in myocardial infarction (TIMI) 0, 1, or 2 and symptom duration ≤ 12 hours treated adjunct to PCI compared to standard PCI. Patients with an ST-segment elevated anterior infarct eligible for PCI will be invited to participate in the PiCSO-AMI-II anterior STEMI study. After consent as per approved ethics committee requirements, baseline assessments will be performed. PCI of the culprit vessel should be performed per standard practices. After TIMI flow restoration, the subjects meeting all eligibility criteria will be enrolled into the study and randomized either to PiCSO Group or Control Group. If the subject is randomized to PiCSO Group, the coronary sinus (CS) will be cannulated through the femoral vein and the PiCSO Impulse Catheter will be placed in the CS. In the event the PiCSO Impulse Catheter cannot be placed in the CS within 30 minutes, the physician should proceed with the regular PCI and the PiCSO treatment will be considered a failure. Once PiCSO Impulse Catheter is placed into CS, PiCSO treatment is started followed by stenting. The physician shall target a PiCSO treatment of 45 minutes whereas the treatment should be continued during and post stent insertion. At the end of the PiCSO treatment, the PiCSO Impulse Console is stopped and the PiCSO Impulse Catheter is removed. The patient is seen at 5 days and 6 months for cardiovascular magnetic resonance imaging (CMR). Follow-up visits will take place at day 5, day 30, 6 months, 1 year, 2 years and 3 years. At every follow-up visit safety data and health status will be documented.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
STEMI - ST Elevation Myocardial Infarction, Anterior Wall Myocardial Infarction
Keywords
PiCSO, PiCSO Impulse System
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Prospective, multicenter, randomized, controlled, parallel-groups
Masking
None (Open Label)
Allocation
Randomized
Enrollment
0 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Control
Arm Type
No Intervention
Arm Description
This is the actual control group receiving conventional therapy, ie. percutaneous coronary intervention.
Arm Title
PiCSO
Arm Type
Experimental
Arm Description
This arm will be treated with Pressure controlled intermittent Coronary Sinus Occlusion (PiCSO) in addition to conventional therapy (percutaneous coronary intervention).
Intervention Type
Device
Intervention Name(s)
PiCSO Impulse System
Intervention Description
After blood flow restoration, the subjects meeting all eligibility criteria will be enrolled into the study and randomized either to PiCSO Group or Control Group. If the subject is randomized to PiCSO Group, the coronary sinus (CS) will be cannulated through the femoral vein and the PiCSO Impulse Catheter will be placed in the CS. Once PiCSO Impulse Catheter is placed into CS, PiCSO treatment is started followed by stenting. The physician shall target a PiCSO treatment of 45 minutes whereas the treatment should be continued during and post stent insertion. At the end of the PiCSO treatment, the PiCSO Impulse Console is stopped and the PiCSO Impulse Catheter is removed.
Primary Outcome Measure Information:
Title
12% performance goal rate of PiCSO device or PiCSO procedure related adverse events reported through 30 days
Description
Primary safety endpoint is based on a 12% performance goal rate of PiCSO device or PiCSO procedure related adverse events reported through 30 days post treatment in patients randomized to PiCSO Group in which the PiCSO treatment was delivered or attempted to be delivered. These events will consist of the composite of:
Femoral venous access site complications:
Major bleed (BARC 3-5)
Infections requiring systemic (oral or intravenous) antibiotic treatment
Any femoral access site-related events requiring surgery
Coronary sinus dissection requiring percutaneous intervention or surgery
Pericardial effusion or tamponade requiring percutaneous intervention or surgery
Embolization or Thrombosis
Stroke
Time Frame
30 days post index PCI
Title
Difference in myocardial infarct size
Description
Difference in myocardial infarct size (extent of myocardial necrosis quantified by delayed gadolinium enhancement presented as a percentage of left ventricular (LV) mass) between the PiCSO Group and the Control Group, assessed by CMR at 5±2 days post index PCI.
Time Frame
5 days post index PCI
Secondary Outcome Measure Information:
Title
Major Adverse Cardiac Event (MACE) at 30 days as well as 1, 2 and 3 years post index PCI
Description
MACE at 30 days as well as 1, 2 and 3 years post index PCI
Cardiovascular death
Cardiovascular hospitalization
Heart failure (HF) hospitalization
New onset or worsening HF
Time Frame
30 days, 1, 2 and 3 years post index PCI
Title
Individual components of the MACE
Description
Individual components of the MACE to be evaluated at 30 days as well as 6 months and 1, 2 and 3 years post index PCI
Time Frame
30 days, 1, 2 and 3 years post index PCI
Title
Classification of all-cause death
Description
Classification of all-cause death at 30 days as well as 6 months and 1, 2 and 3 years post index PCI into the following categories:
Cardiac cause of death
Non-cardiac cause of death
Death of Undetermined Cause
Time Frame
30 days, 6 months, 1, 2 and 3 years post index PCI
Title
Time to death and heart failure hospitalization
Description
The hierarchical composite of time to death within 1 year, time to heart failure hospitalization within one 1-year and infarct size at assessed by CMR at 5±2 days post index PCI.
Time Frame
1 year post index PCI
Title
Myocardial infarct size (% of LV mass) assessed by CMR at 6 months post index PCI
Description
Myocardial infarct size (% of LV mass) assessed by CMR at 6 months post index PCI
Time Frame
6 months post index PCI
Title
Occurrence and extent of microvascular obstruction and hemorrhage
Description
Occurrence and extent of microvascular obstruction (MVO, % of LV mass) and hemorrhage assessed by CMR at 5 days post index PCI
Time Frame
5 days post index PCI
Title
Myocardial function (LVEF, LVESV, LVEDV)
Description
Myocardial function (Left ventricular ejection fraction (LVEF), Left ventricular end-diastolic volume (LVEDV) and Left ventricular end-systolic volume (LVESV)) assessed by CMR at 5 days and 6 months post index PCI
Time Frame
5 days and 6 months post index PCI
Title
Myocardial Salvage Index and myocardial infarct size
Description
Myocardial Salvage Index at 5 days and 6 months post index PCI (derived from Area at Risk (AAR) assessed by CMR at 5 days and myocardial infarct size (% of LV mass) assessed by CMR at 5 days or 6 months, respectively)
Time Frame
5 days and 6 months post index PCI
Title
ST-segment resolution
Description
ST-segment resolution at 60-90 minutes post flow restoration
Time Frame
60-90 minutes post flow restoration
Title
Device success and procedural success rate
Description
Device success and procedural success rate presented as % of subjects
Time Frame
Baseline (treatment day)
Title
Changes in quality of life
Description
Changes in quality of life measured by EQ-5D at 5 days, 6 months and 1, 2, 3 years post index PCI
Time Frame
30 days, 6 months and 1, 2, 3 years post index PCI
Title
Utilization of health resources
Description
Assess health economics by collecting the utilization of health resources throughout the study duration
Time Frame
30 days, 6 months and 1, 2, 3 years post index PCI
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Age ≥18 years old
Culprit lesion in proximal or mid left anterior descending artery (LAD)
Pre-PCI TIMI flow 0, 1 or 2
Symptoms onset time consistent with myocardial ischemia (e.g. persistent chest pain, shortness of breath, nausea/vomiting, fatigue, palpitations or syncope) ≤ 12 h
Electrocardiogram (ECG) evidence of acute anterior myocardial infarction with ST-elevation ≥ 2 mm (0.2 mV) in 2 or more contiguous anterior precordial ECG leads (one of which should be V2, V3, or V4) in men or ≥ 1.5 mm (0.15 mV) in women
Emergent PCI will be performed according to national and local hospital guidelines
Consent per approved national IRB/EC specific requirements prior to the procedure.
Exclusion Criteria:
Patient transferred from an outside hospital where invasive coronary procedure was attempted (including diagnostic catheterization)
Implants or foreign bodies in the coronary sinus
Left main disease >= 50%
Need for treatment of any vessel other than the LAD (or its branches) during the index procedure or before the 5 ± 2 days study CMR.
Known allergy to polyurethanes, polyethylene terephthalate (PET) or stainless steel, both heparin and bivalirudin, or all of clopidogrel, ticagrelor or prasugrel that cannot be adequately pre-medicated
Known pregnancy or breastfeeding
Known large pericardial effusion or cardiac tamponade
Known hemodynamically relevant left to right and right to left shunt
Known previous myocardial infraction (MI)
Previous coronary artery bypass graft (CABG)
Known neurologic abnormality such as tumor or arteriovenous (AV) malformation, history of stroke within 6 months, any prior intracranial bleed or any permanent neurologic defect
History of bleeding diathesis or known coagulopathy (including heparin-induced thrombocytopenia), any recent genitourinary (GU) or gastrointestinal (GI) bleed (within 3 months)
Administration of fibrinolytic therapy within 24 hours prior to enrollment
Cardiogenic shock (systolic blood pressure (SBP) < 90 mmHg), need for mechanical circulatory support, intravenous pressor or pre-randomization intubation
Patients with cardio-pulmonary resuscitated (CPR) cardiac arrest for more than 5 min or whom baseline neurologic status is not present
Patient not suitable for femoral vein access
Contraindication to cardiac magnetic resonance imaging CMR (e.g. claustrophobia, foreign body implants incompatible with CMR, gadolinium intolerance)
Active participation in another drug or device investigational study that has not reached its primary endpoint
Known severe kidney disease (eGFR <=30 mL/min/1.73 m2 by MDRD formula) or on hemodialysis
Chronic obstructive pulmonary disease (COPD) with home oxygen therapy or on chronic steroid therapy
Unconscious on presentation
Patients under judicial protection, legal guardianship or curatorship
Subject has other medical illness (e.g., cancer, dementia) or known history of substance abuse (alcohol, cocaine, heroin, etc.) that may cause non-compliance with the protocol, confound the data interpretation, or is associated with limited life expectancy of less than 1 year
Patients with definite or probable COVID-19 diagnosis > 4 weeks prior to the current MI unless they had returned to their baseline state of health after recovery from the COVID-19 illness
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gregg W. Stone, Prof.
Organizational Affiliation
Mount Sinai, New York, US
Official's Role
Principal Investigator
12. IPD Sharing Statement
Learn more about this trial
A Study to Evaluate the Safety and Efficacy of PiCSO in Anterior STEMI Patients
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