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Zotarolimus-eluting Endeavor Sprint Stent in Uncertain DES Candidates (ZEUS) Study (ZEUS)

Primary Purpose

Coronary Artery Disease

Status
Unknown status
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Bare metal stent implantation
zotarolimus eluting stent
Sponsored by
Marco Valgimigli
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Coronary Artery Disease focused on measuring Bare metal stent, zotarolimus eluting stent, triple anti-thrombotic therapy, high bleeding riskduration of dual anti-platelet therapy

Eligibility Criteria

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

Inclusion Criteria:

A) low restenosis risk based on angiographic findings defined as follows:

----patients will be considered at low restenosis risk if no planned stent lower than 3.0 mm is intended to be implanted in lesions expect left main or vein graft

B) high bleeding risk and/or presence of relative-absolute contraindication to dual anti-platelet treatment beyond 30 days defined as follows:

  1. Clinical indication to treatment with oral anticoagulant, including use of warfarin or dabigatran or other oral anticoagulant agents
  2. Recent (within previous 12 months) bleeding episode(s) which required medical attention
  3. Previous bleeding episode(s) which required hospitalization if the bleeding diathesis has not been completely resolved (i.e. surgical removal of the bleeding source)
  4. Age greater than 80
  5. Systemic conditions associated to increased bleeding risk (e.g. hematological disorders or any known coagulopathy determining bleeding diathesis, including history of or current thrombocytopenia defined as platelet count <100,000/mm3 (<100 x 109/L).
  6. Known Anemia defined as repeatedly documented hemoglobin lower than 10 gr/dl which is not due to an acute and documented blood loss
  7. Need for chronic treatment with steroids or NSAID

C) Patients at high thrombosis risk based on the presence of at least one of the following criteria:

  1. Allergy/intolerance to aspirin
  2. Allergy/intolerance to clopidogrel AND ticlopidine
  3. Planned surgery (other than skin) within 12 months of percutaneous coronary intervention (PCI).
  4. patient with cancers (other than skin) and life expectancy >1 year
  5. Patients with systemic conditions associated with thrombosis diathesis (e.g., hematologic disorders and any known systemic conditions determining a pro-thrombotic state including immunological disorders)

    -

    Exclusion Criteria:

    • Any of the following:

      1. Women who are pregnant. Women of childbearing potential must have a negative pregnancy test (urine or serum HCG) within 7 days prior to randomization; as close to randomization as possible, within 24 hours preferred.
      2. Subjects who are unable to give informed consent and assurance for complete contact through 12 months.
      3. PCI with stenting in the previous 6 months

Sites / Locations

  • Albert Szent-Györgyi Clinical Center, University of Szeged
  • Ospedale San Donato
  • Ospedali Riuniti di Bergamo
  • Policlinico San Marco
  • Ospedale di Savigliano
  • Istituto Clinico Sant'Ambrogio
  • Azienda Unita' Sanitaria Locale Di Modena - Ospedale Baggiovara
  • Azienda Ospedaliero-Universitaria di Parma
  • Policlinico San Matteo
  • Ospedale di Ravenna
  • Azienda Ospedaliera Ordine Mauriziano di Torino, Ospedale Umberto I
  • Ospedale San Giovanni Bosco
  • University Hospital of Ferrara
  • Clinica Mediterranea
  • Hospital de Santa Cruz
  • University Hospital of Geneva

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

bare metal stent

Endeavor sprint stent

Arm Description

Outcomes

Primary Outcome Measures

MACE
Major adverse cardiovascular events including death for any cause, non-fatal myocardial infarction or target vessel revascularisation

Secondary Outcome Measures

Death
myocardial infarction
TVR
target vessel revascularisation
stent thrombosis

Full Information

First Posted
June 24, 2011
Last Updated
October 6, 2012
Sponsor
Marco Valgimigli
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1. Study Identification

Unique Protocol Identification Number
NCT01385319
Brief Title
Zotarolimus-eluting Endeavor Sprint Stent in Uncertain DES Candidates (ZEUS) Study
Acronym
ZEUS
Official Title
Zotarolimus-eluting Endeavor Sprint Stent in Uncertain DES Candidates (ZEUS) Study
Study Type
Interventional

2. Study Status

Record Verification Date
October 2012
Overall Recruitment Status
Unknown status
Study Start Date
June 2011 (undefined)
Primary Completion Date
September 2012 (Actual)
Study Completion Date
December 2017 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Marco Valgimigli

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
To prospectively evaluate in a multicenter open label trial whether the use of zotarolimus-eluting ENDEAVOR Stent implantation in patients at low restenosis or at high bleeding or thrombotic risk will decrease the incidence of 12-month major adverse cardiac events (MACE) including overall death, any myocardial infarction (MI) or any target vessel revascularization (TVR).
Detailed Description
The aim of this study is to conduct a multicenter, international, randomized trial to test whether the Endeavor stent is superior to BMS in terms of efficacy and safety in Patients with coronary artery disease lesions at low risk of in-stent restenosis; Patients at high risk for bleeding or carrying impossibility to comply with dual anti-platelet treatment at long-term. Patients at high thrombosis risk due to systemic disorders or planned non-cardiac surgery within 12 months As the use of DES in these two patient/lesion subsets is debated due to lack of evidence, patients fulfilling at least one of these three medical conditions qualify for bare metal stent implantation and physicians may believe DES to be even contra-indicated in such cases. The current protocol has been developed on purpose to address the value of the Endeavor Sprint stent, which differs in many aspects from other FDA approved DES, including fast and complete degree of strut coverage after implantation and quick release of active drug after deployment (~15 days) which may help decreasing the need for prolonged dual antiplatelet treatment down to 1 month as it is currently recommended for bare metal stent implantation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Coronary Artery Disease
Keywords
Bare metal stent, zotarolimus eluting stent, triple anti-thrombotic therapy, high bleeding riskduration of dual anti-platelet therapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
1606 (Actual)

8. Arms, Groups, and Interventions

Arm Title
bare metal stent
Arm Type
Active Comparator
Arm Title
Endeavor sprint stent
Arm Type
Experimental
Intervention Type
Device
Intervention Name(s)
Bare metal stent implantation
Intervention Description
After BMS implantation the duration of dual anti-platelet therapy is a function of the clinical presentation and the bleeding risk a given patient as follows: Clopidogrel will be given for 1 month after PCI if indication to the procedure is stable coronary artery disease or for at least 6 month if indication to the procedure is ACS, including STEMI or NSTEACS. At discretion of the treating physician, prasugrel or ticagrelor may replace clopidogrel in ACS patients. Patients recruited in the study due to high bleeding risk will receive clopidogrel for at least 30 days. Patients recruited in the study due to high thrombosis risk will receive clopidogrel monotherapy life long or DAPT for at least 1 month.
Intervention Type
Device
Intervention Name(s)
zotarolimus eluting stent
Intervention Description
After ZES implantation the duration of dual anti-platelet therapy is a function of the clinical presentation and the bleeding risk a given patient (i.e. identical to criteria set out for BMS patients) as follows: Clopidogrel will be given for 1 month after PCI if indication to the procedure is stable coronary artery disease or for at least 6 month if indication to the procedure is ACS, including STEMI or NSTEACS. At discretion of the treating physician, prasugrel or ticagrelor may replace clopidogrel in ACS patients. Patients recruited in the study due to high bleeding risk will receive clopidogrel for at least 30 days. Patients recruited in the study due to high thrombosis risk will receive clopidogrel monotherapy life long or DAPT for at least 1 month.
Primary Outcome Measure Information:
Title
MACE
Description
Major adverse cardiovascular events including death for any cause, non-fatal myocardial infarction or target vessel revascularisation
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Death
Time Frame
12 months
Title
myocardial infarction
Time Frame
12 months
Title
TVR
Description
target vessel revascularisation
Time Frame
12 months
Title
stent thrombosis
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: A) low restenosis risk based on angiographic findings defined as follows: ----patients will be considered at low restenosis risk if no planned stent lower than 3.0 mm is intended to be implanted in lesions expect left main or vein graft B) high bleeding risk and/or presence of relative-absolute contraindication to dual anti-platelet treatment beyond 30 days defined as follows: Clinical indication to treatment with oral anticoagulant, including use of warfarin or dabigatran or other oral anticoagulant agents Recent (within previous 12 months) bleeding episode(s) which required medical attention Previous bleeding episode(s) which required hospitalization if the bleeding diathesis has not been completely resolved (i.e. surgical removal of the bleeding source) Age greater than 80 Systemic conditions associated to increased bleeding risk (e.g. hematological disorders or any known coagulopathy determining bleeding diathesis, including history of or current thrombocytopenia defined as platelet count <100,000/mm3 (<100 x 109/L). Known Anemia defined as repeatedly documented hemoglobin lower than 10 gr/dl which is not due to an acute and documented blood loss Need for chronic treatment with steroids or NSAID C) Patients at high thrombosis risk based on the presence of at least one of the following criteria: Allergy/intolerance to aspirin Allergy/intolerance to clopidogrel AND ticlopidine Planned surgery (other than skin) within 12 months of percutaneous coronary intervention (PCI). patient with cancers (other than skin) and life expectancy >1 year Patients with systemic conditions associated with thrombosis diathesis (e.g., hematologic disorders and any known systemic conditions determining a pro-thrombotic state including immunological disorders) - Exclusion Criteria: Any of the following: Women who are pregnant. Women of childbearing potential must have a negative pregnancy test (urine or serum HCG) within 7 days prior to randomization; as close to randomization as possible, within 24 hours preferred. Subjects who are unable to give informed consent and assurance for complete contact through 12 months. PCI with stenting in the previous 6 months
Facility Information:
Facility Name
Albert Szent-Györgyi Clinical Center, University of Szeged
City
Szeged
Country
Hungary
Facility Name
Ospedale San Donato
City
Arezzo
State/Province
AR
ZIP/Postal Code
52100
Country
Italy
Facility Name
Ospedali Riuniti di Bergamo
City
Bergamo
State/Province
BG
ZIP/Postal Code
24128
Country
Italy
Facility Name
Policlinico San Marco
City
Zingonia
State/Province
BG
ZIP/Postal Code
24040
Country
Italy
Facility Name
Ospedale di Savigliano
City
Savigliano
State/Province
CN
ZIP/Postal Code
12038
Country
Italy
Facility Name
Istituto Clinico Sant'Ambrogio
City
Milano
State/Province
MI
ZIP/Postal Code
20149
Country
Italy
Facility Name
Azienda Unita' Sanitaria Locale Di Modena - Ospedale Baggiovara
City
Modena
State/Province
MO
ZIP/Postal Code
41100
Country
Italy
Facility Name
Azienda Ospedaliero-Universitaria di Parma
City
Parma
State/Province
PR
ZIP/Postal Code
43126
Country
Italy
Facility Name
Policlinico San Matteo
City
Pavia
State/Province
PV
ZIP/Postal Code
27100
Country
Italy
Facility Name
Ospedale di Ravenna
City
Ravenna
State/Province
RA
ZIP/Postal Code
48121
Country
Italy
Facility Name
Azienda Ospedaliera Ordine Mauriziano di Torino, Ospedale Umberto I
City
Torino
State/Province
TO
ZIP/Postal Code
10128
Country
Italy
Facility Name
Ospedale San Giovanni Bosco
City
Torino
State/Province
TO
ZIP/Postal Code
10154
Country
Italy
Facility Name
University Hospital of Ferrara
City
Ferrara
ZIP/Postal Code
44100
Country
Italy
Facility Name
Clinica Mediterranea
City
Naples
ZIP/Postal Code
80122
Country
Italy
Facility Name
Hospital de Santa Cruz
City
Carnaxide
Country
Portugal
Facility Name
University Hospital of Geneva
City
Geneva
Country
Switzerland

12. IPD Sharing Statement

Citations:
PubMed Identifier
26965932
Citation
Ariotti S, Adamo M, Costa F, Patialiakas A, Briguori C, Thury A, Colangelo S, Campo G, Tebaldi M, Ungi I, Tondi S, Roffi M, Menozzi A, de Cesare N, Garbo R, Meliga E, Testa L, Gabriel HM, Ferlini M, Vranckx P, Valgimigli M; ZEUS Investigators. Is Bare-Metal Stent Implantation Still Justifiable in High Bleeding Risk Patients Undergoing Percutaneous Coronary Intervention?: A Pre-Specified Analysis From the ZEUS Trial. JACC Cardiovasc Interv. 2016 Mar 14;9(5):426-36. doi: 10.1016/j.jcin.2015.11.015.
Results Reference
derived
PubMed Identifier
25720624
Citation
Valgimigli M, Patialiakas A, Thury A, McFadden E, Colangelo S, Campo G, Tebaldi M, Ungi I, Tondi S, Roffi M, Menozzi A, de Cesare N, Garbo R, Meliga E, Testa L, Gabriel HM, Airoldi F, Ferlini M, Liistro F, Dellavalle A, Vranckx P, Briguori C; ZEUS Investigators. Zotarolimus-eluting versus bare-metal stents in uncertain drug-eluting stent candidates. J Am Coll Cardiol. 2015 Mar 3;65(8):805-815. doi: 10.1016/j.jacc.2014.11.053.
Results Reference
derived
PubMed Identifier
24176438
Citation
Valgimigli M, Patialiakas A, Thury A, Colangelo S, Campo G, Tebaldi M, Ungi I, Tondi S, Roffi M, Menozzi A, de Cesare N, Garbo R, Meliga E, Testa L, Gabriel HM, Airoldi F, Ferlini M, Liistro F, Dellavalle A, Vranckx P, Briguori C. Randomized comparison of Zotarolimus-Eluting Endeavor Sprint versus bare-metal stent implantation in uncertain drug-eluting stent candidates: rationale, design, and characterization of the patient population for the Zotarolimus-eluting Endeavor Sprint stent in uncertain DES candidates study. Am Heart J. 2013 Nov;166(5):831-8. doi: 10.1016/j.ahj.2013.07.033. Epub 2013 Sep 26.
Results Reference
derived

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Zotarolimus-eluting Endeavor Sprint Stent in Uncertain DES Candidates (ZEUS) Study

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