AzTrials
AzTrials

Chest PainRIPCORD 2NCT02892903

In the Management of Coronary Artery Disease, Does Routine Pressure Wire Assessment at the Time of Coronary Angiography Affect Management Strategy, Hospital Costs and Outcomes?

A study testing Routine Measurement of FFR in people with Chest Pain and Stable Angina, run by University Hospital Southampton NHS Foundation Trust at 17 sites in United Kingdom.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
Search all trials

Trial summary

A randomised controlled trial to compare two strategies for the investigation of coronary artery disease at the time of angiography. Patients will be randomised to conventional angiography or additional, routine pressure wire assessment - measuring fractional flow reserve (FFR) - in all main vessels judged as being of… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Chest Pain, Stable Angina, Acute Coronary Syndrome
What is being tested?
Routine Measurement of FFR
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,100 participants
Where
17 sitesUnited Kingdom
Study dates
Sep 2016to Mar 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

None listed.

Who cannot join

  • Screening phase exclusion criteria:
  • ≤ 18 years of age
  • Previous enrolment in this trial
  • Currently enrolled into another study unless co-enrolment approved by Chief Investigator (CI) and the clinical trials unit (CTU)
  • Inability to provide informed consent
  • Residence outside the United Kingdom (UK) or other issues limiting the ability to secure clinical follow-up data to one year
Show all 33Show fewer
  • Non-cardiac pathology that may limit survival in the next year
  • Clear contraindication to potential future management with CABG or PCI (patients should be a potential candidate for medical therapy or revascularisation with either PCI or surgery)
  • Heart valve disease of sufficient import to consider valve replacement or other intervention as part of an index management strategy
  • Hypertrophic cardiomyopathy
  • Previous coronary artery surgery of any type
  • Known chronic renal impairment with a current estimated glomerular filtration rate (eGFR) of < 45
  • Anaemia with a current measured haemoglobin of < 100
  • Angiography performed in the context of an ST elevation myocardial infarction event
  • Any patient who at the time of planned angiography manifests haemodynamic instability, or recurrent sustained ventricular arrhythmia, or Mobitz type II or complete heart block
  • Any patient who at the time of planned angiography manifests unstable chest pain symptoms at rest or has required the continuing use of intravenous nitrates or regular opioid analgesia to control symptoms
  • Continuing use of intravenous glycoprotein 2b/3a (GP2b3a) agents before entry to the catheterisation laboratory
  • Known intolerance, hypersensitivity or contraindication to adenosine - including significant reversible airways disease
  • Additional investigations planned (or deemed likely to be required) for the assessment of myocardial ischaemia or viability. Examples of proposed tests that would constitute an exclusion criterion would include, but are not limited to, exercise tolerance testing, stress echocardiography, cardiac MRI viability or perfusion scanning or nuclear myocardial perfusion scanning.
  • Active bleeding at the time of planned index angiography
  • Pregnant women
  • Angiographic phase exclusion criteria:
  • Single vessel occlusive coronary disease (TIMI flow <3) as sole disease
  • Patient not suitable for the immediate performance of a pressure wire assessment of all major vessels for any reason, for example:
  • Patient discomfort
  • Change in the clinical condition or complication of angiography requiring termination of the procedure or immediate intervention
  • Significant use of radiographic contrast or X-Ray exposure during the initial angiography
  • Inadequate angiographic images or failure to intubate any of the coronary vessels
  • Aorto-ostial disease that would preclude accurate assessment of FFR
  • Insufficient laboratory time
  • Uncertain availability of key clinical and trial staff
  • PW use in coronaries declared unsafe (e.g. tight or long disease)
  • PW use in coronaries declared unsuitable (e.g. distal disease or complete cross-filling)

Trial locations and contacts

17 sites in 1 country.

17 sites in 1 country

United Kingdom17 sites
  • Queen Elizabeth Hospital - University Hospitals Birmingham NHS Foundation Trust

    Birmingham, West Midlands, B15 2TH

  • Royal Blackburn Teaching Hospital - East Lancashire Hospitals NHS Trust

    Blackburn, Lancashire, BB2 3HH

  • Royal Bournemouth Hospital - The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust

    Bournemouth, Dorset, BH7 7DW

  • Brighton and Sussex University Hospitals NHS Trust

    Brighton, East Sussex, BN2 5BE

  • Bristol Heart Institute - University Hospitals Bristol NHS Foundation Trust

    Bristol, BS2 8HW

  • Golden Jubilee National Hospital

    Glasgow, Scotland, G81 4DY

  • Castle Hill Hospital - Hull and East Yorkshire Hospitals NHS Trust

    Hull, Yorkshire, HU16 5JQ

  • Leeds General Infirmary - Leeds Teaching Hospitals NHS Trust

    Leeds, Yorkshire, LS1 3EX

  • Liverpool Heart and Chest Hospital NHS Foundation Trust

    Liverpool, Merseyside, L14 3PE

  • King's Mill Hospital - Sherwood Forest Hospitals NHS Foundation Trust

    Mansfield, Nottinghamshire, NG17 4JL

  • Freeman Hospital - Newcastle Hospitals

    Newcastle upon Tyne, Northumberland, NE7 7DN

  • City Hospital - Nottingham University Hospitals NHS Trust

    Nottingham, Nottinghamshire, NG5 1PB

  • Queen Alexandra Hospital - Portsmouth Hospitals NHS Trust

    Portsmouth, Hampshire, PO6 3LY

  • Northern General Hospital - Sheffield Teaching Hospitals

    Sheffield, South Yorkshire, S5 7AU

  • Southampton General Hospital - University Hospitals Southampton NHS Foundation Trust

    Southampton, Hampshire, SO16 6YD

  • Royal Stoke University Hospital - University Hospitals of North Midlands

    Stoke-on-Trent, Staffordshire, ST4 6QG

  • Pinderfields Hospital - The Mid Yorkshire Hospitals NHS Trust

    Wakefield, West Yorkshire, WF1 4DG

Other trials in United Kingdom

About this study

Official title: A Randomised Controlled Trial to Compare Routine Pressure Wire Assessment With Conventional Angiography in the Management of Patients With Coronary Artery Disease.

A randomised controlled trial to compare two strategies for the investigation of coronary artery disease at the time of angiography. Patients will be randomised to conventional angiography or additional, routine pressure wire assessment - measuring fractional flow reserve (FFR) - in all main vessels judged as being of sufficient vessel calibre to allow percutaneous coronary intervention (PCI) (experimental arm).

Read the detailed description

The study will recruit patients undergoing angiography for the investigation of stable angina or for the assessment of a recent, but stabilised, non-ST elevation acute coronary syndrome event. Eligible patients who provide written informed consent will be randomised to conventional angiography or additional, routine pressure wire assessment - measuring fractional flow reserve (FFR) - in all main vessels judged as being of sufficient vessel calibre to allow percutaneous coronary intervention (PCI) (experimental arm). The study pragmatic design allows investigators to conduct all diagnostic and therapeutic management in accordance with prevailing best practice patterns. Study outcome measures will examine resource utilisation, patient reported quality of life and clinical events at 1 year.

Being tested
Routine Measurement of FFR
Keywords
Fractional flow reserve (FFR), Pressure wire (PW), Coronary angiography
Medical subject headings
Chest Pain, Angina, Stable, Acute Coronary Syndrome

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Routine Measurement of FFRDevice

    Also called Pressure wire assessment

    FFR measurement will be performed in all major vessels with normal (TIMI 3) flow. Occluded vessels and vessels with TIMI flow <3 will not be examined but will be 'awarded' an FFR value of 0.5

Study groups in NCT02892903
Study groupRoleWhat they receive
Conventional angiographyNo interventionRoutine angiography will be performed according to local best practice
Routine Measurement of FFRExperimentalAdditional investigation with the measurement of FFR in all major vessels
Receives: Device: Routine Measurement of FFR

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Primary Economic Outcome Measure

    Resource utilisation as determined by hospital care costs at one year; All hospital admissions will be tracked using national hospital episode statistics; the cost of each episode will be derived from a cost model using standard UK tariffs. This analysis will compare the mean (or median) of the total hospital costs recorded for each patient over the 12 month follow-up period.

    Measured: One year

  2. Primary Quality of Life Outcome Measure

    Patient reported quality of life at one year using the EQ-5D health questionnaire.

    Measured: One year

Secondary outcomes (10)
  1. Management strategy information

    • Proportion of vessels deemed to demonstrate flow-limiting disease and targeted for revascularisation in the declared initial management strategy.

    Measured: Reported once: Single declaration at index procedure after randomisation

  2. Management strategy information

    • Proportion of patients scheduled for management with medical therapy, percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in the declared initial management strategy.

    Measured: Reported once: Single declaration at index procedure after randomisation

  3. Angina symptoms

    • Angina symptoms as reported by the research team after the 12 month contact, described by Canadian Cardiovascular Society Grade.

    Measured: One year

  4. Angina symptoms

    • Angina symptoms as reported by the patient with private completion of a screening form at 12 months, described by Canadian Cardiovascular Society Grade.

    Measured: One year

  5. All-cause mortality

    Measured: One year

  6. Number of hospitalisation events

    Measured: One year

  7. Total hospital days

    Measured: One year

  8. Hospitalisation events

    Hospitalisation events coded as cerebro-vascular accident (CVA).

    Measured: One year

  9. Hospitalisation events

    Hospitalisation events coded as myocardial infarction.

    Measured: One year

  10. Hospitalisation events

    Hospitalisation events coded as Coronary revascularisation. This analysis will involve a pre-specified subgroup analysis of:

    • Planned revascularisation - if declared as the index strategy.
    • All additional revascularisation events.

    Measured: One year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Sep 2016 (estimated)
  2. Study startSep 2016
  3. Primary completionDec 2019 (estimated)
  4. Study completionMar 2020 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
1,100 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02892903
Sponsor's protocol ID
RHM CAR0498
Acronym
RIPCORD 2
Status last verified
Aug 2019
First submitted
6 Jul 2016
Last updated
12 Aug 2019
Results posted
No
Data monitoring committee
Yes
Individual data sharing
No

Publications

  • Zir LM, Miller SW, Dinsmore RE, Gilbert JP, Harthorne JW. Interobserver variability in coronary angiography. Circulation. 1976 Apr;53(4):627-32. doi: 10.1161/01.cir.53.4.627.

    PubMed 1253383
  • White CW, Wright CB, Doty DB, Hiratza LF, Eastham CL, Harrison DG, Marcus ML. Does visual interpretation of the coronary arteriogram predict the physiologic importance of a coronary stenosis? N Engl J Med. 1984 Mar 29;310(13):819-24. doi: 10.1056/NEJM198403293101304.

    PubMed 6700670
  • De Bruyne B, Baudhuin T, Melin JA, Pijls NH, Sys SU, Bol A, Paulus WJ, Heyndrickx GR, Wijns W. Coronary flow reserve calculated from pressure measurements in humans. Validation with positron emission tomography. Circulation. 1994 Mar;89(3):1013-22. doi: 10.1161/01.cir.89.3.1013.

    PubMed 8124786
  • 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.

    PubMed 8637515
  • Berger A, Botman KJ, MacCarthy PA, Wijns W, Bartunek J, Heyndrickx GR, Pijls NH, De Bruyne B. Long-term clinical outcome after fractional flow reserve-guided percutaneous coronary intervention in patients with multivessel disease. J Am Coll Cardiol. 2005 Aug 2;46(3):438-42. doi: 10.1016/j.jacc.2005.04.041.

    PubMed 16053955
  • Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van' t Veer M, Klauss V, Manoharan G, Engstrom T, Oldroyd KG, Ver Lee PN, MacCarthy PA, Fearon WF; FAME Study Investigators. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009 Jan 15;360(3):213-24. doi: 10.1056/NEJMoa0807611.

    PubMed 19144937
  • 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.

    PubMed 17531660
  • Pijls NH, Fearon WF, Tonino PA, Siebert U, Ikeno F, Bornschein B, van't Veer M, Klauss V, Manoharan G, Engstrom T, Oldroyd KG, Ver Lee PN, MacCarthy PA, De Bruyne B; FAME Study Investigators. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study. J Am Coll Cardiol. 2010 Jul 13;56(3):177-84. doi: 10.1016/j.jacc.2010.04.012. Epub 2010 May 28.

    PubMed 20537493
  • De Bruyne B, Pijls NH, Kalesan B, Barbato E, Tonino PA, Piroth Z, Jagic N, Mobius-Winkler S, Rioufol G, Witt N, Kala P, MacCarthy P, Engstrom T, Oldroyd KG, Mavromatis K, Manoharan G, Verlee P, Frobert O, Curzen N, Johnson JB, Juni P, Fearon WF; FAME 2 Trial Investigators. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012 Sep 13;367(11):991-1001. doi: 10.1056/NEJMoa1205361. Epub 2012 Aug 27.

    PubMed 22924638
  • Longman K, Curzen N. Should ischemia be the main target in selecting a percutaneous coronary intervention strategy? Expert Rev Cardiovasc Ther. 2013 Aug;11(8):1051-9. doi: 10.1586/14779072.2013.814856.

    PubMed 23984928
  • Toth G, Hamilos M, Pyxaras S, Mangiacapra F, Nelis O, De Vroey F, Di Serafino L, Muller O, Van Mieghem C, Wyffels E, Heyndrickx GR, Bartunek J, Vanderheyden M, Barbato E, Wijns W, De Bruyne B. Evolving concepts of angiogram: fractional flow reserve discordances in 4000 coronary stenoses. Eur Heart J. 2014 Oct 21;35(40):2831-8. doi: 10.1093/eurheartj/ehu094. Epub 2014 Mar 18.

    PubMed 24644308
  • Curzen N, Rana O, Nicholas Z, Golledge P, Zaman A, Oldroyd K, Hanratty C, Banning A, Wheatcroft S, Hobson A, Chitkara K, Hildick-Smith D, McKenzie D, Calver A, Dimitrov BD, Corbett S. Does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain?: the RIPCORD study. Circ Cardiovasc Interv. 2014 Apr;7(2):248-55. doi: 10.1161/CIRCINTERVENTIONS.113.000978. Epub 2014 Mar 18.

    PubMed 24642999
  • Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD; Writing Group on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction. Third universal definition of myocardial infarction. Glob Heart. 2012 Dec;7(4):275-95. doi: 10.1016/j.gheart.2012.08.001. Epub 2012 Sep 26. No abstract available.

    PubMed 25689940
  • Weintraub WS, Mahoney EM, Zhang Z, Chu H, Hutton J, Buxton M, Booth J, Nugara F, Stables RH, Dooley P, Collinson J, Stuteville M, Delahunty N, Wright A, Flather MD, De Cock E. One year comparison of costs of coronary surgery versus percutaneous coronary intervention in the stent or surgery trial. Heart. 2004 Jul;90(7):782-8. doi: 10.1136/hrt.2003.015057.

    PubMed 15201249
  • Zhang Z, Mahoney EM, Stables RH, Booth J, Nugara F, Spertus JA, Weintraub WS. Disease-specific health status after stent-assisted percutaneous coronary intervention and coronary artery bypass surgery: one-year results from the Stent or Surgery trial. Circulation. 2003 Oct 7;108(14):1694-700. doi: 10.1161/01.CIR.0000087600.83707.FD. Epub 2003 Sep 15.

    PubMed 12975252

Questions about this trial

What is this clinical trial studying?

A study testing Routine Measurement of FFR in people with Chest Pain and Stable Angina, run by University Hospital Southampton NHS Foundation Trust at 17 sites in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 0 inclusion and 33 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 12 Aug 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 17 sites in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Primary Economic Outcome Measure (time frame: One year). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02892903, which also lists 21 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Aug 2019.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in