Multi-center Prospective Study to Evaluate Outcomes of the Moderate to Severely Calcified Coronary Lesions (MACE)

Completed

Conditions: Coronary Artery Disease

Interventions: Device: Percutaneous Coronary Intervention

Registration Number: NCT01930214

Lead Sponsor: Abbott Medical Devices

Brief Summary: The objective of this study is to assess the current standard of care treatment outcome in none/mild, moderate and severely calcified coronary lesions using:

* A composite of MACE at 30-day and one (1) year post procedure, and

* Procedural and lesion success

Detailed Description: This prospective, non-randomized, multi-center study includes subjects who meet all of the inclusion and none of the exclusion criteria and sign the ICF. This study may treat up to approximately 500 subjects at up to 50 active sites in the U.S. Subjects may be followed up to three (3) years. Subjects will be stratified into one (1) of three (3) arms based on the degree of calcification in the coronary lesion as defined by this protocol. The duration of the study is expected to be approximately four (4) years.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 350

Inclusion Criteria

Subjects must be at least 18 years of age.
Subjects must be scheduled for percutaneous coronary revascularization involving stent deployment in de novo coronary lesions. Percutaneous coronary revascularization is defined as treatment with commercially available devices that may include but not limited to balloon angioplasty, cutting balloon, rotablation, etc. followed by the stent placement.
Subjects CK-MB must be less than or equal to the upper limit of lab normal value within eight (8) hours prior to procedure. If CK-MB results are not yet available prior to initiating procedure, subjects Troponin I or Troponin T must be less than or equal to the upper limit of lab normal value within eight (8) hours prior to the procedure.
The target lesion must be a de novo coronary lesion that has not been previously treated with any interventional procedure.
The target vessel must be a native coronary artery with:
1. A stenosis ≥ 70% and < 100%, or
2. A stenosis ≥ 50% < 70% with evidence of clinical ischemia
The target vessel reference diameter must be ≥ 2.5mm and ≤ 4.0 mm.
The lesion length must not exceed 40 mm.
The target vessel must have a Thrombolysis In Myocardial Infarction (TIMI) flow three (3) at baseline.

Exclusion Criteria

Inability to understand the study or a history of non-compliance with medical advice.
Unwilling or unable to sign the MACE clinical study ICF.
History of any cognitive or mental health status that would interfere with study participation.
Currently enrolled in any other pre-approval investigational study. This does not apply to long-term post-market studies unless these studies might clinically interfere with the current study endpoints (e.g., limit use of study-required medication, etc.).
Female subjects who are pregnant or planning to become pregnant within the study period.
Known hypersensitivity or contraindication to aspirin, heparin, ticlopidine or clopidogrel without adequate alternative medications.
Known sensitivity to contrast media, which cannot be adequately pre-medicated.
Diagnosed with chronic renal failure unless under hemodialysis, or has a serum creatinine level >2.5 mg/dl.
History of major cardiac intervention within 30-day, not including a PCI procedure for a staging purpose.
Evidence of heart failure by one of the following:

i. Left Ventricular Ejection Fraction (LVEF) ≤ 25% ii. New York Heart Association (NYHA) class III or IV iii. Clinical symptoms
History of a stroke or transient ischemic attack (TIA) within six (6) months
Active peptic ulcer or upper gastrointestinal (GI) bleeding within six (6) months.
History of bleeding diathesis or coagulopathy or intention to refuse blood transfusion if one should become necessary.
Concurrent medical condition with a life expectancy of < 36 months.
History of immune deficiency.
Uncontrolled insulin dependent diabetes.
Evidence of active infections on the day of the index procedure.
Subject has planned cardiovascular intervention within 60 days post index procedure.
Subject with angiographically confirmed evidence of more than two (2) lesions within one (1) vessel or more than one (1) vessel requiring intervention, unless the treatment is staged. See Section 10.1 for more details.
Target lesion is located in a native vessel distal to anastomosis with a saphenous vein graft or Left Internal Mammary Artery/ Right Internal Mammary Artery (LIMA/RIMA) bypass.
Target vessel has angiographically visible or suspected thrombus.
Target vessel appears to be/is excessively tortuous at baseline.
Target lesion is an ostial location (within 5mm of ostium) or an unprotected left main lesion.
Target lesion is a bifurcation (side branch ≥ 1.5mm).
Treatment of the target lesion with the CSI coronary Diamondback Orbital Atherectomy System (OAS).

Study & Design

Study Type: OBSERVATIONAL

Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
None/mild calcification	Percutaneous Coronary Intervention	Presence of readily apparent radiopacities within the vascular wall at the site of the stenosis.
Moderate Calcification	Percutaneous Coronary Intervention	Presence of radiopacities only during the cardiac cycle before contrast injection with calcium extended partially into the target lesion.
Severe calcification	Percutaneous Coronary Intervention	Presence of radiopacities noted without cardiac motion prior to contrast injection involving both sides of the arterial wall in at least one location, total length of calcium (including segmented) must be at least 15mm and extend partially into the target lesion.

Primary Outcome Measures

Name	Time	Method
MACE at 30 Days	30 days post procedure	A Kaplan-Meier analysis was performed to determine the percent probability that a study participant experienced a major adverse cardiac event through 30 days. 30-day MACE is composed of: * Cardiac death * Myocardial Infarction (MI) - defined as a Creatine Kinase Myocardial-Band Isoenzyme (CK-MB) level greater than three (3) times the Upper Limit of Lab Normal (ULN) value with or without new pathologic Q wave * Target Vessel Revascularization (TVR) - defined as a revascularization at the target vessel (inclusive of the target lesion) after the completion of the index procedure

Secondary Outcome Measures

Name	Time	Method
MACE at One (1) Year	One (1) year post procedure	A Kaplan-Meier analysis was performed to determine the percent probability that a study participant experienced a major adverse cardiac event through 1 year. 1-year MACE is composed of: * Cardiac death * Myocardial Infarction (MI) - defined as a Creatine Kinase Myocardial-Band Isoenzyme (CK-MB) level greater than three (3) times the Upper Limit of Lab Normal (ULN) value with or without new pathologic Q wave * Target Vessel Revascularization (TVR) - defined as a revascularization at the target vessel (inclusive of the target lesion) after the completion of the index procedure
Lesion Success	During the procedure	Lesion success is defined as success in facilitating stent delivery with a post-procedural result of \<50% residual stenosis for a given lesion treated during the procedure without severe angiographic complications.
Procedural Success	Participants were followed from baseline procedure through hospital discharge, an expected average of 24 hours	Procedural success is defined as success in facilitating stent delivery with a residual stenosis of \<50% and without the occurrence of an in-hospital MACE.

Trial Locations

Locations (34): Hartford Hospital
🇺🇸
Hartford, Connecticut, United States
East Carolina University
🇺🇸
Greenville, North Carolina, United States
Boone Hospital
🇺🇸
Columbia, Missouri, United States
University of Chicago Medical Center
🇺🇸
Chicago, Illinois, United States
Allegheny General Hospital
🇺🇸
Pittsburgh, Pennsylvania, United States
Tufts Medical Center
🇺🇸
Boston, Massachusetts, United States
Beth Israel Deaconess Medical Center
🇺🇸
Boston, Massachusetts, United States
Houston Methodist Research Institute
🇺🇸
Houston, Texas, United States
Arkansas Heart Hospital
🇺🇸
Little Rock, Arkansas, United States
Duke University Medical Center
🇺🇸
Durham, North Carolina, United States
Glendale Adventist Medical Center
🇺🇸
Glendale, California, United States
Clearwater Cardiovascular & Interventional Consultants
🇺🇸
Clearwater, Florida, United States
MedStar Washington Hospital
🇺🇸
Washington, District of Columbia, United States
Georgia Regents Research Institute
🇺🇸
Augusta, Georgia, United States
Mount Sinai Medical Center Heart Institute
🇺🇸
Miami Beach, Florida, United States
Indiana University
🇺🇸
Indianapolis, Indiana, United States
Cardiovascular Institute of NW Florida
🇺🇸
Panama City, Florida, United States
Prairie Education & Research Cooperative
🇺🇸
Springfield, Illinois, United States
John Hopkins
🇺🇸
Baltimore, Maryland, United States
Baystate Medical Center
🇺🇸
Springfield, Massachusetts, United States
Beaumont Hospital
🇺🇸
Royal Oak, Michigan, United States
McLaren Bay Regional
🇺🇸
Bay City, Michigan, United States
Saint Luke's
🇺🇸
Kansas City, Missouri, United States
Barnes Jewish Hospital
🇺🇸
Saint Louis, Missouri, United States
Jersey Shore Medical Center
🇺🇸
Neptune, New Jersey, United States
Hackensack University Medical Center
🇺🇸
Hackensack, New Jersey, United States
Mount Sinai New York
🇺🇸
New York, New York, United States
OhioHealth Research Institute
🇺🇸
Columbus, Ohio, United States
North Carolina Heart & Vascular Specialists
🇺🇸
Raleigh, North Carolina, United States
University Pittsburg MC - Hamot
🇺🇸
Erie, Pennsylvania, United States
St. John Health System
🇺🇸
Tulsa, Oklahoma, United States
Providence Health Center
🇺🇸
Waco, Texas, United States
University of Tennessee
🇺🇸
Memphis, Tennessee, United States
Mission Research Institute
🇺🇸
New Braunfels, Texas, United States