Fractional Flow Reserve (FFR) Stability in Non-Culprit Vessels at ST Elevation Myocardial Infarction(STEMI)

NCT01065103 | Completed DMC

• 1 other identifier: H09-03435
• Study Type: interventional
• Target: 48
• Locations: 1 country
• Sites: 2

Brief Summary

It has been shown that if it can be accomplished within a 90 minute "door to balloon" time, opening an artery in an acute heart attack situation (ST elevation myocardial infarction or STEMI) is best treated with balloon angioplasty and stenting (percutaneous coronary intervention or PCI). In these situations, there may be narrowings other than the one causing the heart attack (culprit) and studies have shown that delaying treatment of other narrowings for follow-up procedure is better than intervening at the time of the acute MI.

Conditions

Myocardial Infarction

Keywords

STEMI; Primary angioplasty; Non-culprit vessel at STEMI; Fractional Flow Reserve; ST-elevation myocardial infarction; Fractional Flow Reserve in non-culprit vessel at STEMI

Outcome Measures

Primary Outcomes (1)

• FFR measurement

  Baseline and repeated at 4-6 weeks

Study Arms (1)

FFR measurement

EXPERIMENTAL

Procedure: FFR (Fractional Flow Reserve)

Interventions

FFR (Fractional Flow Reserve) PROCEDURE

Single FFR measurement in non-culprit vessel

FFR measurement

Eligibility Criteria

• Age: 19 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Any patient \>18 years of age with an acute STEMI eligible for primary PCI
• Readily identifiable culprit vessel and at least one other (non-culprit) vessel of a least \>50% severity by traditional angiography
• Deemed appropriate for a strategy of delayed revascularization of the NCV.

You may not qualify if:

• Inability to provide informed consent
• Cardiogenic shock or severe (Killip III) congestive heart failure
• Hemodynamically significant ventricular arrhythmias
• Severe recurrent clinically significant ischemia following successful PCI of the IRA
• Thrombocytopenia (platelet count \<100,000)
• Severe anemia (HgB \<100 g/L)
• Major bleeding during hospitalization of the index STEMI

Sponsors & Collaborators

• Cardiology Research UBC: lead
• University of British Columbia: collaborator

Study Sites (2)

Vancouver General Hospital

Vancouver, British Columbia, V5Z 1M9, Canada

Location

St. Paul's Hospital

Vancouver, British Columbia, V6Z 1Y6, Canada

Location

Related Publications (15)

• Canadian Cardiovascular Society; American Academy of Family Physicians; American College of Cardiology; American Heart Association; Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, Hochman JS, Krumholz HM, Lamas GA, Mullany CJ, Pearle DL, Sloan MA, Smith SC Jr, Anbe DT, Kushner FG, Ornato JP, Pearle DL, Sloan MA, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Halperin JL, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B, Tarkington LG, Yancy CW. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2008 Jan 15;51(2):210-47. doi: 10.1016/j.jacc.2007.10.001. No abstract available.

  PMID: 18191746 BACKGROUND

• Keeley EC, Grines CL. Primary percutaneous coronary intervention for every patient with ST-segment elevation myocardial infarction: what stands in the way? Ann Intern Med. 2004 Aug 17;141(4):298-304. doi: 10.7326/0003-4819-141-4-200408170-00010.

  PMID: 15313746 BACKGROUND

• Keeley EC, Grines CL. Should patients with acute myocardial infraction be transferred to a tertiary center for primary angioplasty or receive it at qualified hospitals in the community? The case for emergency transfer for primary percutaneous coronary intervention. Circulation. 2005 Nov 29;112(22):3520-32; discussion 3533. No abstract available.

  PMID: 16320379 BACKGROUND

• Koyama Y, Hansen PS, Hanratty CG, Nelson GI, Rasmussen HH. Prevalence of coronary occlusion and outcome of an immediate invasive strategy in suspected acute myocardial infarction with and without ST-segment elevation. Am J Cardiol. 2002 Sep 15;90(6):579-84. doi: 10.1016/s0002-9149(02)02559-6.

  PMID: 12231080 BACKGROUND

• Hanratty CG, Koyama Y, Rasmussen HH, Nelson GI, Hansen PS, Ward MR. Exaggeration of nonculprit stenosis severity during acute myocardial infarction: implications for immediate multivessel revascularization. J Am Coll Cardiol. 2002 Sep 4;40(5):911-6. doi: 10.1016/s0735-1097(02)02049-1.

  PMID: 12225715 BACKGROUND

• Goldstein JA, Demetriou D, Grines CL, Pica M, Shoukfeh M, O'Neill WW. Multiple complex coronary plaques in patients with acute myocardial infarction. N Engl J Med. 2000 Sep 28;343(13):915-22. doi: 10.1056/NEJM200009283431303.

  PMID: 11006367 BACKGROUND

• Corpus RA, House JA, Marso SP, Grantham JA, Huber KC Jr, Laster SB, Johnson WL, Daniels WC, Barth CW, Giorgi LV, Rutherford BD. Multivessel percutaneous coronary intervention in patients with multivessel disease and acute myocardial infarction. Am Heart J. 2004 Sep;148(3):493-500. doi: 10.1016/j.ahj.2004.03.051.

  PMID: 15389238 BACKGROUND

• Glaser R, Selzer F, Faxon DP, Laskey WK, Cohen HA, Slater J, Detre KM, Wilensky RL. Clinical progression of incidental, asymptomatic lesions discovered during culprit vessel coronary intervention. Circulation. 2005 Jan 18;111(2):143-9. doi: 10.1161/01.CIR.0000150335.01285.12. Epub 2004 Dec 27.

  PMID: 15623544 BACKGROUND

• Kong JA, Chou ET, Minutello RM, Wong SC, Hong MK. Safety of single versus multi-vessel angioplasty for patients with acute myocardial infarction and multi-vessel coronary artery disease: report from the New York State Angioplasty Registry. Coron Artery Dis. 2006 Feb;17(1):71-5. doi: 10.1097/00019501-200602000-00012.

  PMID: 16374145 BACKGROUND

• Chen LY, Lennon RJ, Grantham JA, Berger PB, Mathew V, Singh M, Holmes DR Jr, Rihal CS. In-hospital and long-term outcomes of multivessel percutaneous coronary revascularization after acute myocardial infarction. Am J Cardiol. 2005 Feb 1;95(3):349-54. doi: 10.1016/j.amjcard.2004.09.032.

  PMID: 15670543 BACKGROUND

• Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA; American College of Cardiology Foundation Appropriateness Criteria Task Force; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons; American Association for Thoracic Surgery; American Heart Association, and the American Society of Nuclear Cardiology Endorsed by the American Society of Echocardiography; Heart Failure Society of America; Society of Cardiovascular Computed Tomography. ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: a report by the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol. 2009 Feb 10;53(6):530-53. doi: 10.1016/j.jacc.2008.10.005.

  PMID: 19195618 BACKGROUND

• Lemesle G, de Labriolle A, Bonello L, Torguson R, Kaneshige K, Xue Z, Suddath WO, Satler LF, Kent KM, Lindsay J, Pichard AD, Waksman R. Incidence, predictors, and outcome of new, subsequent lesions treated with percutaneous coronary intervention in patients presenting with myocardial infarction. Am J Cardiol. 2009 May 1;103(9):1189-95. doi: 10.1016/j.amjcard.2009.01.029. Epub 2009 Mar 13.

  PMID: 19406257 BACKGROUND

• Pijls NH, De Bruyne B, Peels K, Van Der Voort PH, Bonnier HJ, Bartunek J Koolen JJ, Koolen JJ. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med. 1996 Jun 27;334(26):1703-8. doi: 10.1056/NEJM199606273342604.

  PMID: 8637515 BACKGROUND

• De Bruyne B, Pijls NH, Bartunek J, Kulecki K, Bech JW, De Winter H, Van Crombrugge P, Heyndrickx GR, Wijns W. Fractional flow reserve in patients with prior myocardial infarction. Circulation. 2001 Jul 10;104(2):157-62. doi: 10.1161/01.cir.104.2.157.

  PMID: 11447079 BACKGROUND

• Pijls NH, van Schaardenburgh P, Manoharan G, Boersma E, Bech JW, van't Veer M, Bar F, Hoorntje J, Koolen J, Wijns W, de Bruyne B. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol. 2007 May 29;49(21):2105-11. doi: 10.1016/j.jacc.2007.01.087. Epub 2007 May 17.

  PMID: 17531660 BACKGROUND

MeSH Terms

Conditions

Myocardial Infarction; ST Elevation Myocardial Infarction

Condition Hierarchy (Ancestors)

Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Vascular Diseases; Infarction; Ischemia; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Necrosis

Study Officials

• David Wood, MD

  University of British Columbia

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: DIAGNOSTIC
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: February 8, 2010
• First Posted: February 9, 2010
• Study Start: March 1, 2010
• Primary Completion: September 1, 2014
• Study Completion: September 1, 2014
• Last Updated: September 9, 2014

Record last verified: 2014-09

Locations

CA (2)