Randomized Evaluation of Shenfu Injection to Reduce Myocardial Injury

Phase 4

• Conditions: Myocardial Infarction
• Interventions: Drug: 5% Glucose Injection; Drug: Shenfu Injection

• Registration Number: NCT04493840
• Lead Sponsor: Beijing Anzhen Hospital

Brief Summary

This study aims to evaluate whether perioperative use of Shenfu Injection, as compared to placebo, could reduce infarct size assessed by cardiac magnetic resonance (CMR) in patients with acute anterior ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

Detailed Description

Shenfu injection is a traditional Chinese medicine formulation containing ginseng (Panax; family: Araliaceae) and aconite (Radix aconiti lateralis preparata, Aconitum carmichaeli Debx; family: Ranunculaceae) with Ginsenosides and aconite alkaloids as the main active ingredients. Its quality is strictly controlled in compliance with the standard of the China Ministry of Public Health (official approval code: certification number Z20043117; No. 110804, Ya'an, China). Animal studies have shown that Shenfu injection has protective effects against reperfusion injury through multiple pharmacologic effects, including scavenging free radicals, inhibiting inflammatory mediators, suppressing cell apoptosis, and inhibiting calcium overload. However, few data are available regarding its efficacy in humans. We aimed to determine whether perioperative use of Shenfu injection, as compared to placebo, might reduce infarct size in patients with STEMI undergoing primary PCI.

Study Timeline

• Study First Submitted: 2020-07-23
• Study First Submitted QC: 2020-07-27
• Study Start: 2020-07-30
• Study First Posted: 2020-07-30
• Status Verified: 2021-09
• Last Update Submitted: 2021-09-02
• Last Update Posted: 2021-09-10
• Primary Completion: 2022-07-31
• Study Completion: 2022-08-31

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 326

Inclusion Criteria

1. Age ≥18 and <75 years.
2. First-time acute anterior STEMI scheduled for primary PCI.
3. ST segment elevation in at least two contiguous precordial leads according to electrocardiogram (>30 min).
4. Symptoms onset ≤12 hours.
5. The presence of proximal or middle left anterior descending branch (LAD) occlusion with pre-PCI TIMI flow 0 or 1 according to baseline coronary angiogram.
6. Written informed consent.

Exclusion Criteria

1. Cardiogenic shock, serious heart failure (Killip class III or above), malignant ventricular arrhythmia, or mechanical complications.
2. Post cardiopulmonary resuscitation (CPR) (including cardioversion).
3. Patients who have received thrombolytic therapy or upstream GPIIb/IIIa inhibitors (GPI).
4. Uncontrolled hypertension (systolic BP ≥180 mm Hg or a diastolic BP ≥110 mmHg).
5. Prior myocardial infarction, PCI or coronary artery bypass graft.
6. Known severe hepatic insufficiency (AST/ALT >3-fold the upper limit of normal value) or known renal insufficiency.
7. Malignant tumor, lymphoma, HIV-positive, or cirrhosis with life expectancy <1 year.
8. Patients with active bleeding, intracranial hemorrhage, major surgery or trauma within 1 months, or ischemic stroke or transient ischemic attack (TIA) within 6 months.
9. History of anemia (hemoglobin<90g/L) or thrombocytopenia (thrombocyte<100×109/L).
10. Patients who require simultaneous intervention of left main disease during primary PCI or those with multi-vessel disease who plan to intervene in non-culprit vessels within 7 days (simultaneous or staged).
11. Scheduled for CABG within one month after randomization.
12. Pregnancy, lactation, or potentially fertile women.
13. Patients who have known to be allergic to Shenfu Injection or its components or patients with serious adverse effect.
14. Patients with contraindication to CMR (metal foreign body in the body, claustrophobia, etc.).
15. Participation in other clinical trial in recent 3 months.
16. Patients who cannot complete this trial or comply with the protocol.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
5% Glucose Injection	5% Glucose Injection	-
Shenfu Injection	Shenfu Injection	-

Primary Outcome Measures

Name	Time	Method
Infarct size (% of left ventricular mass)	5±2 days after PCI	Infarct size was assessed by performing CMR imaging at 5±2 days after PCI

Secondary Outcome Measures

Name	Time	Method
Left ventricular ejection fraction (LVEF)	5±2 days after PCI
Microvascular obstruction (% of left ventricular mass)	5±2 days after PCI
Left ventricular end-diastolic volume (LVEDV)	5±2 days after PCI
AUC of cardiac troponin I	Immediately after admission (0 hour), and 6, 12, 18, 24, 48, and 72 hours after PCI
Peak value of CK-MB and cTnI	72 hours after PCI
ST segment resolution (%) according to ECG	24 hours after PCI
Corrected TIMI frame count (CTFC)	Immediately after PCI
TIMI myocardial perfusion grade (TMPG)	Immediately after PCI
Area at risk (myocardial edema, % of left ventricular mass)	5±2 days after PCI
Individual events (including cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, emergency revascularization, re-hospitalization for heart failure)	30 days after PCI
Intramyocardial hemorrhage (% of left ventricular mass)	5±2 days after PCI
Area under the curve (AUC) of creatine kinase isoenzyme (CK-MB)	Immediately after admission (0 hour), and 6, 12, 18, 24, 48, and 72 hours after PCI
TIMI flow grade	Immediately after PCI
Myocardial salvage index	5±2 days after PCI
Left ventricular end-systolic volume (LVESV)	5±2 days after PCI
Major adverse cardiovascular and cerebrovascular events (MACCE, including cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, emergency revascularization)	30 days after PCI

Trial Locations

Locations (1)

Beijing Anzhen Hospital, Capital Medical University; 🇨🇳 Beijing, China