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The Elderly ACS II Trial

Primary Purpose

Acute Coronary Syndrome, Coronary Arteriosclerosis, Myocardial Ischemia

Status
Unknown status
Phase
Phase 4
Locations
Italy
Study Type
Interventional
Intervention
prasugrel
Clopidogrel
Sponsored by
Arcispedale Santa Maria Nuova-IRCCS
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Coronary Syndrome focused on measuring acute coronary syndrome, elderly, percutaneous revascularization, antiaggregant drugs

Eligibility Criteria

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

Inclusion Criteria:

- Patients >74 years of age hospitalized for an ACS, with or without STE, with an onset of symptoms during the previous 72 hours, and candidates to an early PCI.

  • STEMI patients may be randomized upon first diagnosis, provided they do not meet any exclusion criteria. STEMI patients should not exceed 50 percent of the global population of the study
  • Eligible NSTEACS patients may be randomized after coronary angiography. To be eligible, NSTEACS patients must have at least one of the following characteristics:

    • elevated troponin levels;
    • diabetes mellitus;
    • prior MI;
    • at least one new ischemic episode while on standard treatment during the index hospitalization;
    • ACS due to stent thrombosis.

Exclusion Criteria:

  • History of stroke or transient ischemic attack (TIA)
  • Gastrointestinal or genitourinary bleeding of clinical significance within 6 weeks prior to randomization.
  • Hemoglobin level on admission <10 g/dl, unless this is considered to be secondary to renal dysfunction or known myelodysplasia.
  • Secondary causes of acute myocardial ischemia.
  • Known current platelet count < 90,000 cells/mL.
  • Ongoing oral anticoagulant treatment or an INR known to be >1.5 at the time of screening.
  • Concomitant severe obstructive lung disease, malignancy or neurologic deficit limiting follow-up or adherence to the study protocol.
  • Participation in any phase of another clinical research study involving the evaluation of another investigational drug or device within 30 days prior to randomization
  • Inability to give at least verbal informed consent to the study.
  • Contraindications to the use of clopidogrel or prasugrel as per package leaflet.

Sites / Locations

  • Azienda Ospedaliera "Ospedale Civile di Legnano"Recruiting
  • Arcispedale Santa Maria Nuova- IRCCSRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

prasugrel

clopidogrel

Arm Description

prasugrel 60 mg loading dose, followed by 5 mg once daily until the end of follow-up

Clopidogrel 300 mg loading dose followed by 75 mg once day until the end of follow-up

Outcomes

Primary Outcome Measures

The composite of all-cause mortality, myocardial infarction (MI), disabling stroke and re-hospitalization for cardiovascular causes or bleeding within one year

Secondary Outcome Measures

The composite of burden of recurrent cardiovascular (CV) events, CV mortality, all-cause mortality and MI, major bleeding, any stroke, total number of days spent in hospital.
definition of major bleeding: - Bleeding Academic Research Consortium (BARC) type 2 or 3 bleeding within 1 year (for bleedings occurring during index or subsequent hospitalizations) · BARC type IV bleeding within 1 year

Full Information

First Posted
January 21, 2013
Last Updated
October 19, 2016
Sponsor
Arcispedale Santa Maria Nuova-IRCCS
Collaborators
ANMCO Italian Association of Hospital Cardiologist, Italian Society of Invasive Cardiology
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1. Study Identification

Unique Protocol Identification Number
NCT01777503
Brief Title
The Elderly ACS II Trial
Official Title
Phase IV: A Comparison of Reduced-dose Prasugrel and Clopidogrel in Elderly Patients With Acute Coronary Syndrome Undergoing Early Percutaneous Coronary Intervention (PCI)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2016
Overall Recruitment Status
Unknown status
Study Start Date
November 2012 (undefined)
Primary Completion Date
August 2017 (Anticipated)
Study Completion Date
December 2017 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Arcispedale Santa Maria Nuova-IRCCS
Collaborators
ANMCO Italian Association of Hospital Cardiologist, Italian Society of Invasive Cardiology

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The objective of this study is to compare reduced-dose prasugrel and standard dose clopidogrel in patients older than 74 years with ACS, including non-ST-elevation (NSTEACS) and ST-elevation (STEMI) patients, undergoing early PCI. The primary endpoint of the trial will be the one-year composite of (all-cause)death, myocardial infarction, stroke and re-hospitalization due to cardiovascular reasons or bleeding.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Coronary Syndrome, Coronary Arteriosclerosis, Myocardial Ischemia, Cardiovascular Diseases
Keywords
acute coronary syndrome, elderly, percutaneous revascularization, antiaggregant drugs

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
2000 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
prasugrel
Arm Type
Experimental
Arm Description
prasugrel 60 mg loading dose, followed by 5 mg once daily until the end of follow-up
Arm Title
clopidogrel
Arm Type
Active Comparator
Arm Description
Clopidogrel 300 mg loading dose followed by 75 mg once day until the end of follow-up
Intervention Type
Drug
Intervention Name(s)
prasugrel
Other Intervention Name(s)
Efient
Intervention Description
prasugrel 5 mg o.d.
Intervention Type
Drug
Intervention Name(s)
Clopidogrel
Other Intervention Name(s)
Plavix
Intervention Description
75 mg o.d.
Primary Outcome Measure Information:
Title
The composite of all-cause mortality, myocardial infarction (MI), disabling stroke and re-hospitalization for cardiovascular causes or bleeding within one year
Time Frame
1 year
Secondary Outcome Measure Information:
Title
The composite of burden of recurrent cardiovascular (CV) events, CV mortality, all-cause mortality and MI, major bleeding, any stroke, total number of days spent in hospital.
Description
definition of major bleeding: - Bleeding Academic Research Consortium (BARC) type 2 or 3 bleeding within 1 year (for bleedings occurring during index or subsequent hospitalizations) · BARC type IV bleeding within 1 year
Time Frame
1 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: - Patients >74 years of age hospitalized for an ACS, with or without STE, with an onset of symptoms during the previous 72 hours, and candidates to an early PCI. STEMI patients may be randomized upon first diagnosis, provided they do not meet any exclusion criteria. STEMI patients should not exceed 50 percent of the global population of the study Eligible NSTEACS patients may be randomized after coronary angiography. To be eligible, NSTEACS patients must have at least one of the following characteristics: elevated troponin levels; diabetes mellitus; prior MI; at least one new ischemic episode while on standard treatment during the index hospitalization; ACS due to stent thrombosis. Exclusion Criteria: History of stroke or transient ischemic attack (TIA) Gastrointestinal or genitourinary bleeding of clinical significance within 6 weeks prior to randomization. Hemoglobin level on admission <10 g/dl, unless this is considered to be secondary to renal dysfunction or known myelodysplasia. Secondary causes of acute myocardial ischemia. Known current platelet count < 90,000 cells/mL. Ongoing oral anticoagulant treatment or an INR known to be >1.5 at the time of screening. Concomitant severe obstructive lung disease, malignancy or neurologic deficit limiting follow-up or adherence to the study protocol. Participation in any phase of another clinical research study involving the evaluation of another investigational drug or device within 30 days prior to randomization Inability to give at least verbal informed consent to the study. Contraindications to the use of clopidogrel or prasugrel as per package leaflet.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Stefano Savonitto, MD
Phone
+39-0341-489490
Email
s.savonitto@ospedale.lecco.it
Facility Information:
Facility Name
Azienda Ospedaliera "Ospedale Civile di Legnano"
City
Legnano
State/Province
MI
ZIP/Postal Code
20025
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Stefano De Servi, MD
Email
stefano.deservi@ao-legnano.it
First Name & Middle Initial & Last Name & Degree
Stefano De Servi, MD
Facility Name
Arcispedale Santa Maria Nuova- IRCCS
City
Reggio Emilia
ZIP/Postal Code
42123
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Stefano Savonitto, MD
Phone
+39-0341-489490
Email
s.savonitto@ospedale.lecco.it
First Name & Middle Initial & Last Name & Degree
Stefano Savonitto, MD

12. IPD Sharing Statement

Citations:
PubMed Identifier
30636561
Citation
Crimi G, Morici N, Ferrario M, Ferri LA, Piatti L, Grosseto D, Cacucci M, Mandurino Mirizzi A, Toso A, Piscione F, De Carlo M, Elia LR, Trimarco B, Bolognese L, Bovenzi FM, De Luca G, Savonitto S, De Servi S. Time Course of Ischemic and Bleeding Burden in Elderly Patients With Acute Coronary Syndromes Randomized to Low-Dose Prasugrel or Clopidogrel. J Am Heart Assoc. 2019 Jan 22;8(2):e010956. doi: 10.1161/JAHA.118.010956.
Results Reference
derived
PubMed Identifier
29459361
Citation
Savonitto S, Ferri LA, Piatti L, Grosseto D, Piovaccari G, Morici N, Bossi I, Sganzerla P, Tortorella G, Cacucci M, Ferrario M, Murena E, Sibilio G, Tondi S, Toso A, Bongioanni S, Ravera A, Corrada E, Mariani M, Di Ascenzo L, Petronio AS, Cavallini C, Vitrella G, Rogacka R, Antonicelli R, Cesana BM, De Luca L, Ottani F, De Luca G, Piscione F, Moffa N, De Servi S; Elderly ACS 2 Investigators. Comparison of Reduced-Dose Prasugrel and Standard-Dose Clopidogrel in Elderly Patients With Acute Coronary Syndromes Undergoing Early Percutaneous Revascularization. Circulation. 2018 Jun 5;137(23):2435-2445. doi: 10.1161/CIRCULATIONAHA.117.032180. Epub 2018 Feb 19.
Results Reference
derived
PubMed Identifier
27823681
Citation
Ferri LA, Morici N, Grosseto D, Tortorella G, Bossi I, Sganzerla P, Cacucci M, Sibilio G, Tondi S, Toso A, Ferrario M, Gandolfo N, Ravera A, Mariani M, Corrada E, Di Ascenzo L, Petronio AS, Cavallini C, Moffa N, De Servi S, Savonitto S. A comparison of reduced-dose prasugrel and standard-dose clopidogrel in elderly patients with acute coronary syndromes undergoing early percutaneous revascularization: Design and rationale of the randomized Elderly-ACS 2 study. Am Heart J. 2016 Nov;181:101-106. doi: 10.1016/j.ahj.2016.08.010. Epub 2016 Aug 26.
Results Reference
derived
Links:
URL
http://dx.doi.org/10.1016/j.ahj.2016.08.010
Description
Design and rationale of the randomized Elderly-ACS 2 study

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The Elderly ACS II Trial

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