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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Withdrawn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
Miracor Medical SA
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for STEMI - ST Elevation Myocardial Infarction focused on measuring PiCSO, PiCSO Impulse System

Eligibility Criteria

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

Inclusion Criteria:

  1. Age ≥18 years old
  2. Culprit lesion in proximal or mid left anterior descending artery (LAD)
  3. Pre-PCI TIMI flow 0, 1 or 2
  4. Symptoms onset time consistent with myocardial ischemia (e.g. persistent chest pain, shortness of breath, nausea/vomiting, fatigue, palpitations or syncope) ≤ 12 h
  5. 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
  6. Emergent PCI will be performed according to national and local hospital guidelines
  7. Consent per approved national IRB/EC specific requirements prior to the procedure.

Exclusion Criteria:

  1. Patient transferred from an outside hospital where invasive coronary procedure was attempted (including diagnostic catheterization)
  2. Implants or foreign bodies in the coronary sinus
  3. Left main disease >= 50%
  4. 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.
  5. 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
  6. Known pregnancy or breastfeeding
  7. Known large pericardial effusion or cardiac tamponade
  8. Known hemodynamically relevant left to right and right to left shunt
  9. Known previous myocardial infraction (MI)
  10. Previous coronary artery bypass graft (CABG)
  11. 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
  12. History of bleeding diathesis or known coagulopathy (including heparin-induced thrombocytopenia), any recent genitourinary (GU) or gastrointestinal (GI) bleed (within 3 months)
  13. Administration of fibrinolytic therapy within 24 hours prior to enrollment
  14. Cardiogenic shock (systolic blood pressure (SBP) < 90 mmHg), need for mechanical circulatory support, intravenous pressor or pre-randomization intubation
  15. Patients with cardio-pulmonary resuscitated (CPR) cardiac arrest for more than 5 min or whom baseline neurologic status is not present
  16. Patient not suitable for femoral vein access
  17. Contraindication to cardiac magnetic resonance imaging CMR (e.g. claustrophobia, foreign body implants incompatible with CMR, gadolinium intolerance)
  18. Active participation in another drug or device investigational study that has not reached its primary endpoint
  19. Known severe kidney disease (eGFR <=30 mL/min/1.73 m2 by MDRD formula) or on hemodialysis
  20. Chronic obstructive pulmonary disease (COPD) with home oxygen therapy or on chronic steroid therapy
  21. Unconscious on presentation
  22. Patients under judicial protection, legal guardianship or curatorship
  23. 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
  24. 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

    First Posted
    August 8, 2022
    Last Updated
    March 22, 2023
    Sponsor
    Miracor Medical SA
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    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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