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ST Segment Elevation Myocardial InfarctionEARLYmyoQFR-IINCT03910400

Early Assessment of QFR in STEMI-II

A study testing Computation of quantitative flow ratio in people with ST Segment Elevation Myocardial Infarction, run by RenJi Hospital at 1 site in China.

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 The sponsor has not verified this record for over two years, so it may be out of date.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

The study intends to provide new data on whether the noval method using quantitative flow ratio could assess microvascular dysfunction based on the previous study EARLY-MYO-QFR-I. Read more about this study

Who is it for?
Any age
What is being tested?
Computation of quantitative flow ratio
Could I receive a placebo?
No, everyone receives an active treatment
How many people
200 participants
Where
1 siteChina
Study dates
1 Feb 2019to 1 Mar 2021
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 Any age
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • STEMI patients treated with revasculation within 12 hours from onset of symptoms to PCI time and received CMR 5 days afterwards. STEMI was defined as a combination of the following: chest pain for more than 30min, electrocardiographic (ECG) changing with ST segment elevation of >2 mm in at least 2 precordial leads and >1 mm in limb leads, and abnormal troponin levels or CKMB levels higher than twice the upper limit of normal.
  • Stents were implanted whenever technically possible.
  • TFG 2/3 after PCI.

Who cannot join

  • Patients with left bundle branch block in the presenting ECG, cardiogenic shock, previous PCI or bypass surgery, previous AMI history.
  • Patients with trouble in partially inflating a balloon catheter during pharmacologic hyperemia.
  • Patients with unqualified coronary angiographic images with problems such as ostial lesion, severe vessel tortuosity and diffuse long lesions.

Trial locations and contacts

1 site in 1 country.

China1 site, 1 recruiting
  • Ren Ji Hospital Afflited to School of Medicine, Shanghai Jiao Tong University

    Shanghai

    Jun Pu, 86-21-68383477, pujun310@hotmail.com

    Recruiting

Other trials in China

About this study

Official title: EARLY Microvascular Dysfunction Assessment Using Quantitative Flow Ratio After ST-segment Elevation MYOcardial Infarction (EARLY-MYO-QFR II)

The study intends to provide new data on whether the noval method using quantitative flow ratio could assess microvascular dysfunction based on the previous study EARLY-MYO-QFR-I.

Read the detailed description

Microvascular dysfunction (MVD) is a serious complication of PCI, which happens frequently after STEMI and always correlates with a poor prognosis. However, precise and simplified assessment of MVD is difficult, especially in the acute phase of STEMI patients. Resent studies suggested that FFR could be overestimated when MVD exists. But whether the overestimated value of FFR caused by CMR defined microvascular obstruction (MVO) could reflect microvascular function is still unclear.

In the previous study EARLY-MYO-QFR-I, we have demonstrated that the relationship between Contrast-enhanced CMR defined MVO and QFR. While angiography images were collected on a retrospectively manner, and the study population were selected (STEMI patients with spontaneously recanalized culprit vessel before PCI) to verify our hypothesis.

This phase of study would be a prospective study. We tend to created a new study population by a temporary artificial stenosis inside the stent by partially inflating a balloon catheter during pharmacologic hyperemia in STEMI patients.

Being tested
Computation of quantitative flow ratio
Keywords
STEMI, Cardiac magnetic resonance, balloon catheter
Medical subject headings
ST Elevation Myocardial Infarction

What participants receive

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

  • Computation of quantitative flow ratioDiagnostic test

    After stents were implanted whenever technically possible in the STEMI patients, the investigators created a temporary artificial stenosis inside the stent by partially inflating a balloon catheter during pharmacologic hyperemia.

    Computation of QFR was performed offline, using AngioPlus system(Pluse medical imaging technology, Shanghai, China). In the first step, 2 diagnostic angiographic projections with the artifical stenosis, at least 25° apart, were selected and 3D reconstruction of the interrogated vessel without its side branches was performed. Then, the software computed the QFR.

Study groups in NCT03910400
Study groupRoleWhat they receive
MVO groupExperimentalCMR was performed in all the cases. According to the results of CMR, we divided the study population into MVO group and Non-MVO group.
Receives: Diagnostic Test: Computation of quantitative flow ratio
Non-MVO groupExperimentalCMR was performed in all the cases. According to the results of CMR, we divided the study population into MVO group and Non-MVO group.
Receives: Diagnostic Test: Computation of quantitative flow ratio

What is being measured

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

  1. Cardiac magnetic resonance (CMR)

    Cardiac magnetic resonance (CMR) is a non-invasive test for MVO assessing

    Measured: Five days after PCI

Secondary outcomes (3)
  1. TIMI Flow Grade (TFG)

    TIMI Flow Grade (TFG) assesses flow in the epicardial arteries. Type zero perfusion expressed not antegrade movement away the occlusion; type two is a minimum, inadequate perfusion of contrast average round the mass; type three (partial perfusion) is a perfect just limited perfusion from the distal coronary bed by contrast element; and type three (complete perfusion) is an antegrade movement to the whole distal artery at a regular flow.

    Measured: One minutes after PCI

  2. TIMI Myocardial Perfusion Grade (TMPG)

    TIMI Myocardial Perfusion Grade (TMPG) assesses flow in the microvessels. TMPG0: no or minimal blush; TMPG1: Stain present Blush persists on next injection; TMPG2: Dye strongly persistent at end of washout Gone by next injection; TMPG3: normal ground glass appearance of blush Dye mildly persistent at end of washout.

    Measured: One minutes after PCI

  3. ST-segment resolution (STR)

    The ST-segment resolution (STR) was measured after the end of the QRS complex J point in leads I, aVL, and V1 to V6 for anterior MI, and leads II, III, aVF, V5, and V6 for nonanterior MI.

    Measured: 90 minutes after PCI

Timeline

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

  1. First posted10 Apr 2019
  2. Study start1 Feb 2019
  3. Primary completion1 Jan 2021 (estimated)
  4. Study completion1 Mar 2021 (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
Non-randomised
Intervention model
Single group
Masking
Single blind
Who is masked
Investigator
Enrolment
200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03910400
Sponsor's protocol ID
16CR3034B
Acronym
EARLYmyoQFR-II
Status last verified
Jun 2019
First submitted
9 Apr 2019
Last updated
10 Apr 2020
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Niccoli G, Burzotta F, Galiuto L, Crea F. Myocardial no-reflow in humans. J Am Coll Cardiol. 2009 Jul 21;54(4):281-92. doi: 10.1016/j.jacc.2009.03.054.

    PubMed 19608025
  • Sheng X, Ding S, Ge H, Sun Y, Kong L, He J, Pu J, He B. Intracoronary infusion of alprostadil and nitroglycerin with targeted perfusion microcatheter in STEMI patients with coronary slow flow phenomenon. Int J Cardiol. 2018 Aug 15;265:6-11. doi: 10.1016/j.ijcard.2018.04.119. Epub 2018 Apr 25.

    PubMed 29728334
  • Fearon WF, Balsam LB, Farouque HM, Caffarelli AD, Robbins RC, Fitzgerald PJ, Yock PG, Yeung AC. Novel index for invasively assessing the coronary microcirculation. Circulation. 2003 Jul 1;107(25):3129-32. doi: 10.1161/01.CIR.0000080700.98607.D1. Epub 2003 Jun 23.

    PubMed 12821539
  • Fearon WF, Shah M, Ng M, Brinton T, Wilson A, Tremmel JA, Schnittger I, Lee DP, Vagelos RH, Fitzgerald PJ, Yock PG, Yeung AC. Predictive value of the index of microcirculatory resistance in patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2008 Feb 5;51(5):560-5. doi: 10.1016/j.jacc.2007.08.062.

    PubMed 18237685
  • Fearon WF, Low AF, Yong AC, McGeoch R, Berry C, Shah MG, Ho M, Kim HS, Loh JP, Oldroyd KG. Response to letter regarding article, "Prognostic value of the index of microcirculatory resistance measured after primary percutaneous coronary intervention". Circulation. 2014 Feb 18;129(7):e342. doi: 10.1161/CIRCULATIONAHA.113.007271. No abstract available.

    PubMed 24550557
  • van de Hoef TP, Nolte F, EchavarrIa-Pinto M, van Lavieren MA, Damman P, Chamuleau SA, Voskuil M, Verberne HJ, Henriques JP, van Eck-Smit BL, Koch KT, de Winter RJ, Spaan JA, Siebes M, Tijssen JG, Meuwissen M, Piek JJ. Impact of hyperaemic microvascular resistance on fractional flow reserve measurements in patients with stable coronary artery disease: insights from combined stenosis and microvascular resistance assessment. Heart. 2014 Jun;100(12):951-9. doi: 10.1136/heartjnl-2013-305124. Epub 2014 Apr 11.

    PubMed 24727867
  • Tu S, Echavarria-Pinto M, von Birgelen C, Holm NR, Pyxaras SA, Kumsars I, Lam MK, Valkenburg I, Toth GG, Li Y, Escaned J, Wijns W, Reiber JH. Fractional flow reserve and coronary bifurcation anatomy: a novel quantitative model to assess and report the stenosis severity of bifurcation lesions. JACC Cardiovasc Interv. 2015 Apr 20;8(4):564-74. doi: 10.1016/j.jcin.2014.12.232. Epub 2015 Mar 26.

    PubMed 25819180
  • Emori H, Kubo T, Kameyama T, Ino Y, Matsuo Y, Kitabata H, Terada K, Katayama Y, Aoki H, Taruya A, Shimamura K, Ota S, Tanaka A, Hozumi T, Akasaka T. Diagnostic Accuracy of Quantitative Flow Ratio for Assessing Myocardial Ischemia in Prior Myocardial Infarction. Circ J. 2018 Feb 23;82(3):807-814. doi: 10.1253/circj.CJ-17-0949. Epub 2018 Jan 16.

    PubMed 29343675
  • Spitaleri G, Tebaldi M, Biscaglia S, Westra J, Brugaletta S, Erriquez A, Passarini G, Brieda A, Leone AM, Picchi A, Ielasi A, Girolamo DD, Trani C, Ferrari R, Reiber JHC, Valgimigli M, Sabate M, Campo G. Quantitative Flow Ratio Identifies Nonculprit Coronary Lesions Requiring Revascularization in Patients With ST-Segment-Elevation Myocardial Infarction and Multivessel Disease. Circ Cardiovasc Interv. 2018 Feb;11(2):e006023. doi: 10.1161/CIRCINTERVENTIONS.117.006023.

    PubMed 29449325
  • Tu S, Westra J, Yang J, von Birgelen C, Ferrara A, Pellicano M, Nef H, Tebaldi M, Murasato Y, Lansky A, Barbato E, van der Heijden LC, Reiber JHC, Holm NR, Wijns W; FAVOR Pilot Trial Study Group. Diagnostic Accuracy of Fast Computational Approaches to Derive Fractional Flow Reserve From Diagnostic Coronary Angiography: The International Multicenter FAVOR Pilot Study. JACC Cardiovasc Interv. 2016 Oct 10;9(19):2024-2035. doi: 10.1016/j.jcin.2016.07.013.

    PubMed 27712739
  • Pu J, Ding S, Ge H, Han Y, Guo J, Lin R, Su X, Zhang H, Chen L, He B; EARLY-MYO Investigators. Efficacy and Safety of a Pharmaco-Invasive Strategy With Half-Dose Alteplase Versus Primary Angioplasty in ST-Segment-Elevation Myocardial Infarction: EARLY-MYO Trial (Early Routine Catheterization After Alteplase Fibrinolysis Versus Primary PCI in Acute ST-Segment-Elevation Myocardial Infarction). Circulation. 2017 Oct 17;136(16):1462-1473. doi: 10.1161/CIRCULATIONAHA.117.030582. Epub 2017 Aug 27.

    PubMed 28844990
  • Cuculi F, De Maria GL, Meier P, Dall'Armellina E, de Caterina AR, Channon KM, Prendergast BD, Choudhury RP, Forfar JC, Kharbanda RK, Banning AP. Impact of microvascular obstruction on the assessment of coronary flow reserve, index of microcirculatory resistance, and fractional flow reserve after ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2014 Nov 4;64(18):1894-904. doi: 10.1016/j.jacc.2014.07.987. Epub 2014 Oct 27.

    PubMed 25444143
  • Mejia-Renteria H, Lee JM, Lauri F, van der Hoeven NW, de Waard GA, Macaya F, Perez-Vizcayno MJ, Gonzalo N, Jimenez-Quevedo P, Nombela-Franco L, Salinas P, Nunez-Gil I, Del Trigo M, Goto S, Lee HJ, Liontou C, Fernandez-Ortiz A, Macaya C, van Royen N, Koo BK, Escaned J. Influence of Microcirculatory Dysfunction on Angiography-Based Functional Assessment of Coronary Stenoses. JACC Cardiovasc Interv. 2018 Apr 23;11(8):741-753. doi: 10.1016/j.jcin.2018.02.014.

    PubMed 29673505

Questions about this trial

What is this clinical trial studying?

A study testing Computation of quantitative flow ratio in people with ST Segment Elevation Myocardial Infarction, run by RenJi Hospital at 1 site in China.

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 3 inclusion and 3 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 10 Apr 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. 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?

Contact Jun Pu, MD,PhD (86-21-68383477, pujun310@hotmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Cardiac magnetic resonance (CMR) (time frame: Five days after PCI). 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 NCT03910400, which also lists 13 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 10 Apr 2020.

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