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Chronic Total Occlusion (CTO)FACT-2NCT07020858

FAPI Imaging Predicts Adverse Cardiac Events in Chronic Total Occlusion

An observational study of Chronic Total Occlusion (CTO) and Chronic Coronary Syndrome, run by Lin Zhao at 1 site in China.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Prospective, observational, single-center cohort study Hypothesis Higher myocardial FAPI uptake in CTO patients predicts a greater incidence of major adverse cardiovascular events (MACE) within 12 months after PCI. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
FAPl lmaging
How many people
470 participants
Where
1 siteChina
Study dates
15 Apr 2025to 15 Mar 2027
How long will I take part?
2 Years
Phase
Observational
Are there results?
Not yet: the study is under way

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

Study population: Patients presenting with at least one coronary chronic total occlusion (CTO) on coronary angiogram who will be treated by percutaneous coronary intervention

Who may be able to join

  • Age ≥18 years.
  • Confirmed diagnosis of ≥1 untreated chronic total occlusion (CTO):Defined as complete occlusion of a major coronary artery or relevant collateral (reference vessel diameter ≥2.5 mm or confirmed by two independent interventional cardiologists), with TIMI flow grade 0 in the distal segment and duration ≥3 months.Preoperatively confirmed by coronary angiography or coronary computed tomography angiography (CTCA).
  • Willingness to undergo FAPI-PET imaging and receive PCI under imaging guidance.
  • Ability to provide written informed consent.

Who cannot join

  • Contraindications to antiplatelet therapy: Allergy or intolerance to aspirin, clopidogrel, or ticagrelor.
  • Severe liver dysfunction: Liver function parameters exceeding 3× the upper limit of normal.
  • Severe chronic kidney disease: Estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m².
  • Life expectancy <1 year due to non-cardiovascular comorbidities.
  • Pregnancy or women of childbearing potential (unless surgically sterile or using contraception).

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

China1 site, 1 recruiting
  • Beijing Chaoyang Hospital,Capital Medical University,Beijing,China

    Beijing, Beijing Municipality, 100020

    Recruiting

Other trials in China

About this study

Official title: The Value of FAPI Imaging for the Prediction of Adverse Cardiovascular Events in Chronic Total Occlusion of Coronary Artery Disease (FACT-2 Trial)

Prospective, observational, single-center cohort study

Hypothesis Higher myocardial FAPI uptake in CTO patients predicts a greater incidence of major adverse cardiovascular events (MACE) within 12 months after PCI. FAPI PET/CT imaging is associated with plaque vulnerability features and may serve as a non-invasive marker for fibrotic activity and adverse cardiac remodeling.

Read more

Inclusion Criteria

  • Age ≥ 18 years
  • Presence of at least one untreated chronic total occlusion (CTO) lesion in a major coronary artery (diameter ≥ 2.5 mm, TIMI 0 flow for ≥ 3 months) confirmed by coronary angiography or CTCA
  • Patient eligible for PCI and undergoing FAPI PET/CT imaging prior to intervention
  • Written informed consent provided

Exclusion Criteria

  • Allergy or contraindication to antiplatelet agents (aspirin, clopidogrel, or ticagrelor)
  • Severe liver dysfunction (liver enzymes >3× upper limit of normal)
  • Severe chronic kidney disease (eGFR < 30 mL/min/1.73 m²)
  • Estimated life expectancy < 1 year
  • Pregnancy or potential for pregnancy

Primary Endpoint Incidence of 1-year MACE, defined as a composite of: Cardiac death, Myocardial infarction, Stroke, Urgent revascularization

Secondary Endpoints

  • All-Cause Mortality
  • Death from any cause within 12 months
  • Quality of Life Change: Measured by Seattle Angina Questionnaire (SAQ): changes in angina frequency, physical limitation, and treatment satisfaction
  • Repeat PCI Events: Incidence of: In-stent restenosis (ISR): ≥50% luminal loss in previously stented segment; Target lesion revascularization (TLR): at original PCI lesion; Target vessel revascularization (TVR): other sites in same vessel; De novo lesions: new lesions not previously treated

Sample Size Estimated 470 patients

Follow-Up Duration 12 months post-PCI, One follow-up visit including clinical exam, SAQ questionnaire, imaging (PET/CT, echocardiography), and laboratory testing.

Read the detailed description

Chronic total occlusion (CTO) of coronary arteries represents one of the most complex and challenging subsets of coronary artery disease and is associated with increased cardiovascular risk. While percutaneous coronary intervention (PCI) for CTO lesions has evolved substantially due to advances in imaging, devices, and operator experience, long-term prognostic evaluation remains suboptimal. In particular, no imaging biomarker currently allows non-invasive prediction of major adverse cardiovascular events (MACE) following CTO PCI.

Fibroblast activation plays a central role in myocardial fibrosis and atherosclerotic plaque instability, both of which contribute to adverse cardiovascular outcomes.

The fibroblast activation protein inhibitor (FAPI), labeled with radionuclides for PET/CT imaging, has recently emerged as a promising tool for quantifying fibrotic activity both in the myocardium and within coronary plaques. Preliminary data from the original FACT study showed that FAPI imaging may predict ventricular remodeling 6 months post-PCI. However, its long-term prognostic value and its role in detecting plaque vulnerability have not been fully evaluated in prospective studies.

The FACT-2 study is a prospective observational cohort study designed to evaluate whether FAPI PET/CT imaging can predict 1-year MACE in patients with CTO undergoing PCI. All enrolled patients will undergo baseline 18F-FAPI PET/CT scans prior to PCI and will be followed for 12 months post-intervention. The study aims to establish a FAPI-based risk stratification model, integrating FAPI uptake parameters with plaque morphology (via OCT and histopathology), serological fibrosis markers, and patient-reported quality of life scores.

The primary endpoint of the study is the incidence of MACE, defined as a composite of cardiac death, myocardial infarction, stroke, and urgent revascularization within one year of PCI. Secondary endpoints include all-cause mortality, repeat PCI events (including in-stent restenosis, target lesion/vessel revascularization, and de novo lesion intervention), and quality of life changes assessed by the Seattle Angina Questionnaire (SAQ).

In this study, FAPI uptake will be quantified by multiple parameters including total uptake volume (FAPI%), standardized uptake values (SUVmax, SUVmean), and target-to-background ratio (TBR). These parameters will be analyzed for correlation with clinical outcomes and histopathological features of plaque vulnerability (e.g., positive remodeling, microcalcification, lipid-rich necrotic core). The goal is to determine whether FAPI PET/CT can serve as a novel imaging biomarker for both myocardial and systemic fibrotic activity and stratify future cardiovascular risk.

By addressing the current evidence gaps in CTO prognosis and risk stratification, the FACT-2 study aims to provide scientific and clinical justification for incorporating molecular imaging into routine management of complex coronary artery disease. This study will also contribute to a more personalized treatment paradigm, bridging the gap between anatomical repair and biologically targeted intervention in cardiovascular medicine.

Being tested
FAPl lmaging
Keywords
Coronary Heart Disease, Major adverse cardiovascular events (MACE), Plaque vulnerability, Optical coherence tomography (OCT), Fibroblast activation protein inhibitor (FAPI), Percutaneous coronary intervention (PCI)
Medical subject headings
Coronary Disease

What participants receive

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

  • FAPl lmagingDiagnostic test

    Studies have shown that imaging with radionuclide-labeled fibroblast activation protein inhibitor (FAPl) is a reliable technique for detecting myocardial fibrosis and activated CFs in arteries. Preliminary evidence suggests that FAPl imaging can assess plaque characteristics and the status of myocardial fibrosis in various cardiovascular diseases.

Study groups in NCT07020858
Study groupRoleWhat they receive
Patients with at least one untreated CTOat basal angiographyTotal occlusion in any major coronary vessel or relevant side branches [reference vessel diameter >2.5 mm or as judged by two independent interventional cardiologists], with TIMI 0 in the distal segment and at least 3 months old
Receives: Diagnostic Test: FAPl lmaging

What is being measured

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

  1. Incidence of Major Adverse Cardiovascular Events (MACE)

    MACE is defined as a composite of cardiac death, myocardial infarction, stroke, and urgent revascularization (including in-stent restenosis, target lesion revascularization, or target vessel revascularization). Events will be assessed through clinical follow-up and hospital record review.

    Measured: 12 months after percutaneous coronary intervention (PCI)

Secondary outcomes (3)
  1. All-Cause Mortality

    Death from any cause, including cardiovascular and non-cardiovascular causes, occurring within 12 months after the index PCI procedure.

    Measured: 12 months post-PCI, verified through national death registry and hospital records.

  2. Change in Quality of Life

    Assessed using the Seattle Angina Questionnaire (SAQ). Outcome domains include angina frequency, physical limitation, and treatment satisfaction. Comparison is made between baseline and 12-month follow-up.

    Measured: At baseline and 12 months post-PCI.

  3. Repeat Percutaneous Coronary Intervention (Repeat PCI)

    Incidence of repeat PCI due to recurrent or new coronary lesions within 12 months, categorized as:

    In-Stent Restenosis (ISR): ≥50% luminal narrowing in the original stented segment, with or without symptoms.

    Target Lesion Revascularization (TLR): Reintervention at the original stent site due to restenosis or thrombosis.

    Target Vessel Revascularization (TVR): Intervention in the same coronary artery, but outside the original stent site.

    De Novo Lesion: New lesion in a vessel not treated during the index PCI. Confirmation based on follow-up angiography.

    Measured: Within 12 months following the index PCI procedure.Angiographic confirmation

Timeline

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

  1. First posted13 Jun 2025
  2. Study start15 Apr 2025
  3. Primary completion15 Mar 2026 (estimated)
  4. Study completion15 Mar 2027 (estimated)

Resources

More details

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

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
470 participants (estimated)
Target duration
2 Years
IDs, dates and publications
ClinicalTrials.gov ID
NCT07020858
Sponsor's protocol ID
2025-ke-415
Acronym
FACT-2
Status last verified
Jun 2025
First submitted
6 Jun 2025
Last updated
19 Jun 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Only IPD used in the results publication

Publications

  • Park TK, Lee SH, Choi KH, Lee JM, Yang JH, Song YB, Hahn JY, Choi JH, Gwon HC, Lee SH, Choi SH. Late Survival Benefit of Percutaneous Coronary Intervention Compared With Medical Therapy in Patients With Coronary Chronic Total Occlusion: A 10-Year Follow-Up Study. J Am Heart Assoc. 2021 Mar 16;10(6):e019022. doi: 10.1161/JAHA.120.019022. Epub 2021 Mar 4.

    PubMed 33660515
  • Werner GS, Hildick-Smith D, Martin Yuste V, Boudou N, Sianos G, Gelev V, Rumoroso JR, Erglis A, Christiansen EH, Escaned J, Di Mario C, Teruel L, Bufe A, Lauer B, Galassi AR, Louvard Y. Three-year outcomes of A Randomized Multicentre Trial Comparing Revascularization and Optimal Medical Therapy for Chronic Total Coronary Occlusions (EuroCTO). EuroIntervention. 2023 Sep 18;19(7):571-579. doi: 10.4244/EIJ-D-23-00312.

    PubMed 37482940
  • Yang L, Guo L, Lv H, Liu X, Zhong L, Ding H, Zhou X, Zhu H, Huang R. Predictors of Adverse Events Among Chronic Total Occlusion Patients Undergoing Successful Percutaneous Coronary Intervention and Medical Therapy. Clin Interv Aging. 2021 Oct 14;16:1847-1855. doi: 10.2147/CIA.S337069. eCollection 2021.

    PubMed 34703218

Questions about this trial

What is this clinical trial studying?

An observational study of Chronic Total Occlusion (CTO) and Chronic Coronary Syndrome, run by Lin Zhao 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 4 inclusion and 5 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: looking for participants now, as of the sponsor's last update on 19 Jun 2025. 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Shengwen Yang, Dr (+8601085231480 ext. +8617801014018, verayang1990@163.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of Major Adverse Cardiovascular Events (MACE) (time frame: 12 months after percutaneous coronary intervention (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 NCT07020858, which also lists 3 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 19 Jun 2025.

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