MedPath

Phase III Acute Coronary Syndrome

Phase 3
Terminated
Conditions
Acute Coronary Syndrome
Interventions
Drug: Placebo
Registration Number
NCT00831441
Lead Sponsor
Bristol-Myers Squibb
Brief Summary

The purpose of this study is to determine if apixaban is superior to placebo for preventing cardiovascular death, non-fatal myocardial infarction, or ischemic stroke in subjects with a recent acute coronary syndrome

Detailed Description

Not available

Recruitment & Eligibility

Status
TERMINATED
Sex
All
Target Recruitment
7484
Inclusion Criteria
  • Acute coronary syndrome (ACS)
  • Clinically stable
  • Receiving standard of care for ACS
Exclusion Criteria
  • Severe hypertension
  • Active bleeding or high risk for major bleeding
  • Hemoglobin < 9 g/dL

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
PlaceboPlacebo-
ApixabanApixaban-
Primary Outcome Measures
NameTimeMethod
Event Rate of Confirmed Major Bleeding Using Thrombolysis in Myocardial Infarction (TIMI) Criteria During the Treatment Period - Treated ParticipantsFrom first dose to first occurrence of event (TIMI major bleeding) during Treatment Period (first dose to last dose + 2 days), up to March 2011, approximately 2 years

TIMI Major Bleed Criteria: Fatal bleeding, intracranial hemorrhage, and clinically overt bleeding with a hemoglobin (Hgb) drop of ≥ 5 grams per deciliter (g/dL), or ≥15% absolute decrease in hematocrit. To account for transfusions, Hgb measurements were adjusted for transfusions. A transfusion of 1 unit of blood was assumed to result in an increase by 1 g/dL in Hgb or 3% in hematocrit. Event rate was percent of participants with an event of Major Bleed as per TIMI (number of participants with event/number randomized) per 100 patient (100-pt) years. Only events confirmed by the adjudication committee were included in the analyses. Treatment Period=events with onset from first dose to last dose plus 2 days.

Event Rate of Cardiovascular Death, Myocardial Infarction, or Ischemic Stroke During the Intended Treatment Period - Randomized ParticipantsRandomization (Day 1) to first event (CV death, MI, ischemic stroke), up to March 2011, approximately 2 years

Event rate was percent of participants with an event of cardiovascular (CV) death, myocardial infarction (MI), or ischemic stroke (number of participants with event/number randomized) per 100 patient (100-pt) years. Study was terminated early and last patient, last visit was in Year 2. Only events confirmed by the adjudication committee were included in the analyses. CV death included deaths due to CV causes (eg, cardiogenic shock, heart failure, arrhythmia/sudden death, cardiac rupture, ischemic stroke, pulmonary embolism, venous/arterial thrombotic events) and other sudden deaths for which an alternative cause was not identified. Intended Treatment Period: the period that started on the day of randomization and ended at the efficacy cut-off date (cut-off date: the date all sites were informed that study drug should be discontinued for all participants, 18 November 2010).

Secondary Outcome Measures
NameTimeMethod
Event Rate of Myocardial Infarction (MI) During the Intended Treatment Period - Randomized ParticipantsRandomization (Day 1) to first event (MI), up to March 2011, approximately 2 years

MI took into account whether the participant had a recent percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. Selected key criteria: Elevation of cardiac biomarkers (eg, Creatine Kinase MB fraction (CKMB), Troponin T, Troponin I) above the upper reference limit (URL) plus ischemic symptoms, ECG changes, or imaging evidence of new loss of viable myocardium or new regional wall motion abnormality; Death of CV etiology with new ST-segment elevation or left bundle branch block (LBBB) or fresh intracoronary thrombus by angiography or at autopsy occurring before biomarkers could be obtained or before their appearance in the blood; Following a PCI, elevation of cardiac biomarkers more than 3\*URL; Following CABG surgery, elevation of cardiac biomarkers more than 5\*URL; New, significant (≥0.04 s) Q waves in ≥2 contiguous leads; Pathologic findings of acute MI. Intended Treatment Period: Day of randomization (Day 1) to efficacy cut-off notice.

Event Rate of Unstable Angina (UA) During the Intended Treatment Period - Randomized ParticipantsRandomization (Day 1) to first event of UA, up to March 2011, approximately 2 years

Unstable Angina (UA) defined as worsening or recurrent severe or repetitive angina symptoms at rest lasting at least 10 minutes with at least 2 of the following: New and dynamic electrocardiogram (ECG) changes; angina symptoms leading to inpatient hospitalization; angina symptoms leading to an unplanned or urgent cardiac catheterization, with or without revascularization, that showed evidence of hemodynamically and clinically significant stenosis. Event rate was percent of participants with an event of unstable angina (number of participants with event/number randomized) per 100 patient (100-pt) years. Only events confirmed by the adjudication committee were included in the analyses. Intended Treatment Period: the period that started on the day of randomization and ended at the efficacy cut-off date (cut-off date: the date all sites were informed that study drug should be discontinued for all participants, 18 November 2010).

Event Rate of Stroke During the Intended Treatment Period - Randomized ParticipantsRandomization (Day 1) to first event (stroke), up to March 2011, approximately 2 years

Event rate was percent of participants with an event of stroke (number of participants with event/number randomized) per 100 patient (100-pt) years. Only events confirmed by the adjudication committee were included in the analyses. Diagnosis of stroke required a new, non-traumatic, focal neurological deficit of sudden onset, lasting at least 24 hours that was not due to a readily identifiable non-vascular cause (ie, brain tumor). All strokes were classified as hemorrhagic (documentation on imaging (eg computed tomography scan or magnetic resonance imaging) of hemorrhage in the cerebral parenchyma, or a subdural or subarachnoid hemorrhage), non-hemorrhagic/ischemic stroke, ischemic stroke with hemorrhagic conversion, or type unknown. Intended Treatment Period: the period that started on the day of randomization (Day 1) and ended at the efficacy cut-off date (notification of study termination).

Event Rate of All Bleeding Reported by the Investigator During the Treatment Period - Treated ParticipantsFrom first dose to first occurrence of event (Bleeding) during Treatment Period (first dose to last dose + 2 days), up to March 2011, approximately 2 years

Bleeding events were adjudicated by the Adjudication Committee and classified according to Thrombolysis in Myocardial Infarction (TIMI) major, minor, minimal, and International Society on Thrombosis and Hemostasis (ISTH) major and clinically relevant non-major bleeding (CRNM) criteria. The adjudicated results based on TIMI and ISTH classifications, and programmatically identified events (not adjudicated) according to Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) classification were used in the analyses of bleeding endpoints. GUSTO Bleed Criteria included Severe or life-threatening: Intracranial hemorrhage, or bleeding that causes hemodynamic compromise requiring intervention; Moderate: Bleeding that requires a blood transfusion, but does not result in hemodynamic compromise; Mild: Bleeding that does not meet criteria for either severe or moderate bleeding. Treatment Period=events with onset from first dose to last dose plus 2 days.

Event Rate of Composite of Cardiovascular Death, Myocardial Infarction, Unstable Angina, or Ischemic Stroke During the Intended Treatment Period - Randomized ParticipantsRandomization (Day 1) to first event (CV death, MI, UA, Ischemic Stroke, up to March 2011, approximately 2 years

Event rate was percent of participants with an event of CV death, MI, unstable angina (UA), or ischemic stroke (number of participants with event/number randomized) per 100-pt years. Only events confirmed by the adjudication committee were included in the analyses. Each type of event was counted once per participant, but participants could have been counted in multiple categories. Intended Treatment Period: Day of randomization (Day 1) to efficacy cut-off date (notification of study termination).

Event Rate of Composite of Cardiovascular Death, Fatal Bleed, Myocardial Infarction, or Stroke During the Intended Treatment Period - Randomized ParticipantsRandomization (Day 1) to first event (CV death, Fatal Bleed, MI, or stroke), up to March 2011, approximately 2 years

Event rate was percent of participants with an event of CV death, fatal bleed, MI, or stroke (number of participants with event/number randomized) per 100 patient (100-pt) years. Only events confirmed by the adjudication committee were included in the analyses. CV death included deaths due to CV causes; Diagnosis of stroke required a new, non-traumatic, focal neurological deficit of sudden onset, lasting at least 24 hours that was not due to a readily identifiable non-vascular cause; Fatal bleeding defined as bleeding that Adjudication Committee determined was the primary cause of death or contributed directly to death; MI took into account whether the participant had a recent PCI or CABG surgery. Intended Treatment Period: Day of randomization (Day 1) to efficacy cut-off date (notification of study termination).

Event Rate of Confirmed Major Bleeding or Clinically Relevant Non-Major Bleeding (CRNM) Using ISTH Criteria During the Treatment Period - Treated ParticipantsFrom first dose to first occurrence of event (ISTH major or CRNM bleed) during Treatment Period (first dose to last dose + 2 days), up to March 2011, approximately 2 years

ISTH Major bleed: acute clinically overt bleeding accompanied by one or more of the following: A decrease in Hgb of 2 g/dL or more over 24 hours; A transfusion of 2 or more units of packed RBCs; Bleeding that occurs in at least one of the following critical sites: intracranial, intraspinal, intraocular (within the corpus of the eye), pericardial, intra-articular, intramuscular with compartment syndrome, retroperitoneal; Bleeding that was fatal. CRNM: acute clinically overt bleeding that did not satisfy additional criteria required for the bleeding event to be defined as a major bleeding event and meets at least one of the following: Hospital admission for bleeding; Physician guided medical or surgical treatment for bleeding; Change in anti-thrombotic treatment (anticoagulant or antiplatelet) therapy. Bleeding events were adjudicated by the Adjudication Committee. Treatment Period=events with onset from first dose to last dose plus 2 days.

Event Rate of Stent Thrombosis During the Intended Treatment Period - Randomized ParticipantsRandomization (Day 1) to first event (stent thrombosis), up to March 2011, approximately 2 years

Stent thrombosis: Definite stent thrombosis considered to have occurred by either angiographic or pathological confirmation; Probable stent thrombosis considered to have occurred in the following cases: any unexplained death within the first 30 days after stent implantation; irrespective of the time after the procedure, any MI that was related to documented acute ischemia in the territory of the implanted stent without angiographic confirmation of stent thrombosis and in the absence of any other obvious cause; Possible stent thrombosis considered to have occurred with any unexplained death from 30 days after intracoronary stenting until end of study (in Year 2). Event rate was percent of participants with an event of stent thrombosis (number with event/number randomized) per 100-pt years. Only events confirmed by the adjudication committee were included in the analyses. Intended Treatment Period: Day of randomization (Day 1) to efficacy cut-off notice of study termination.

Event Rate of Composite of All-Cause Death, Myocardial Infarction, or Stroke During the Intended Treatment Period - Randomized ParticipantsRandomization (Day 1) to first event (All Cause Death, MI, or Stroke), up to March 2011, approximately 2 years

Cause of death was determined by the principal condition that caused the death, not the immediate mode of death.

CV death: included deaths due to CV causes. Non-CV death: included non-CV deaths caused primarily by a malignancy, infection, bleeding, trauma, non-CV system organ failure, or non-CV surgery. Unknown: included deaths that were not attributable to one of the above categories of CV death or to a non-CV cause. MI accounted whether the participant had a recent PCI or CABG surgery. Diagnosis of stroke required a new, non-traumatic, focal neurological deficit of sudden onset, lasting at least 24 hours that was not due to a readily identifiable non-vascular cause. Only events confirmed by the adjudication committee were included in analyses. Intended Treatment Period: Day of randomization (Day 1) to efficacy cut-off date (notification of study termination).

Event Rate of Confirmed Major Bleeding Using International Society on Thrombosis and Hemostasis (ISTH) Criteria During the Treatment Period - Treated ParticipantsFrom first dose to first occurrence of event (ISTH major bleed) during Treatment Period (first dose to last dose + 2 days), up to March 2011, approximately 2 years

ISTH Criteria: Acute clinically overt bleeding defined as new onset, visible bleeding or signs or symptoms suggestive of bleeding confirmed by imaging techniques, which can detect the presence of blood (eg, ultrasound, CT, MRI). Major bleeding: acute clinically overt bleeding accompanied by one or more of the following: A decrease in Hgb of 2 g/dL or more over 24 hours; A transfusion of 2 or more units of packed red blood cells (RBCs); Bleeding that occurs in at least one of the following sites: intracranial, intraspinal, intraocular (within the corpus of the eye; thus, a conjunctival bleed is not an intraocular bleed), pericardial, intra-articular, intramuscular with compartment syndrome, retroperitoneal; Bleeding that was fatal. Bleeding events were adjudicated by the Adjudication Committee. Event rate was percent of participants with an event (number with event/number randomized) per 100-pt years. Treatment Period=events with onset from first dose to last dose plus 2 days.

Trial Locations

Locations (206)

Central Jersey Medical Research Center

🇺🇸

Elizabeth, New Jersey, United States

Delmarva Heart Research Foundation

🇺🇸

Salisbury, Maryland, United States

Washington University School Of Medicine

🇺🇸

St. Louis, Missouri, United States

Carl Wilson Sofley, Jr., Md

🇺🇸

Anderson, South Carolina, United States

Lowcountry Medical Group

🇺🇸

Beaufort, South Carolina, United States

Parkway Cardiology Associates, Pc

🇺🇸

Oak Ridge, Tennessee, United States

William Beaumont Hospital-Troy

🇺🇸

Troy, Michigan, United States

Med Tech, Inc.

🇺🇸

Houston, Texas, United States

Methodist Debakey Heart & Vascular Center

🇺🇸

Houston, Texas, United States

Heart Center Research, Llc

🇺🇸

Huntsville, Alabama, United States

Sparks Regional Medical Center

🇺🇸

Fort Smith, Arkansas, United States

Nea Baptist Clinic

🇺🇸

Jonesboro, Arkansas, United States

Phase Care, Llc

🇺🇸

Alameda, California, United States

Cardiology Consultants Of Orange County

🇺🇸

Anaheim, California, United States

Escondido Cardiology Associates, Inc.

🇺🇸

Escondido, California, United States

Local Institution

🇬🇧

New Castle Upon Tyne, Tyne And Wear, United Kingdom

William D. Bowden, D.O.

🇺🇸

Healdsburg, California, United States

California Heart Specialists, Inc.

🇺🇸

Huntington Beach, California, United States

Eisenstein, Isaac

🇺🇸

Lakewood, California, United States

Caring Clinical Research Corporation

🇺🇸

Laguna Hills, California, United States

Preciado Cardiology Incorporated

🇺🇸

Los Angeles, California, United States

East Bay Physicians Medical Group

🇺🇸

Oakland, California, United States

Arvind J. Mehta, Md

🇺🇸

Long Beach, California, United States

St. Joseph Heritage Medical Group

🇺🇸

Orange, California, United States

A.R.I. Clinical Trials, Inc.

🇺🇸

Redondo Beach, California, United States

Harbbor-Ucla Medical Center

🇺🇸

Torrance, California, United States

Coastal Multi-Specialty Research

🇺🇸

Santa Ana, California, United States

Radiant Research, Inc

🇺🇸

Santa Rosa, California, United States

Rocky Mountain Cardiology

🇺🇸

Boulder, Colorado, United States

South Denver Cardiology Associates Pc

🇺🇸

Littleton, Colorado, United States

Palm Beach Heart Institute, Llc

🇺🇸

Atlantis, Florida, United States

Orlando Heart Specialists

🇺🇸

Altamonte Springs, Florida, United States

Hartford Hospital

🇺🇸

Hartford, Connecticut, United States

Drogue Medical, Llc

🇺🇸

Wheat Ridge, Colorado, United States

Alfieri Cardiology

🇺🇸

Newark, Delaware, United States

The Heart And Vascular Institute Of Florida

🇺🇸

Clearwater, Florida, United States

Ronald L. Walsh, Do

🇺🇸

Clearwater, Florida, United States

David E. Perloff, Md

🇺🇸

Ft. Lauderdale, Florida, United States

Cardiovascular Specialist Of South Florida

🇺🇸

Davie, Florida, United States

Nature Coast Clinical Research

🇺🇸

Inverness, Florida, United States

Jacksonville Heart Center, Pa

🇺🇸

Jacksonville, Florida, United States

Jacksonville Center For Clinical Research

🇺🇸

Jacksonville, Florida, United States

East Coast Institute For Research

🇺🇸

Jacksonville, Florida, United States

Alpha Medical Research, Llc

🇺🇸

Melbourne, Florida, United States

The Cardio Vascular Center P.A.

🇺🇸

Lake Mary, Florida, United States

Mount Sinai Medical Center

🇺🇸

Miami Beach, Florida, United States

Mediquest Research Group Inc.

🇺🇸

Ocala, Florida, United States

Melbourne Internal Medicine Associates (Mima)

🇺🇸

Melbourne, Florida, United States

Ocala Research Institute, Inc

🇺🇸

Ocala, Florida, United States

Palm Beach Gardens Research Center Llc

🇺🇸

Palm Beach Gardens, Florida, United States

Cardiology Consultants

🇺🇸

Pensacola, Florida, United States

Advent Clinical Research Centers, Inc.

🇺🇸

Pinellas Park, Florida, United States

Cardio-Pulmonary Associates

🇺🇸

Plantation, Florida, United States

Avivo Clin Clinical Services

🇺🇸

Port Orange, Florida, United States

Heartcare Research

🇺🇸

Sarasota, Florida, United States

St. Augustine Cardiology Associates

🇺🇸

St. Augustine, Florida, United States

Howard T. Tee, M.D., F.A.C.P., F.A.C.C.

🇺🇸

Vero Beach, Florida, United States

Indian River Cardiovascular Associates, Inc

🇺🇸

Vero Beach, Florida, United States

Cardiology Partners Clinical Research Institute

🇺🇸

Wellington, Florida, United States

Cardiovascular Physicians Of North Atlanta

🇺🇸

Atlanta, Georgia, United States

Columbus Cardiology Associates Pc

🇺🇸

Columbus, Georgia, United States

Medical College Of Georgia

🇺🇸

Augusta, Georgia, United States

Georgia Heart Specialists

🇺🇸

Covington, Georgia, United States

Atlanta Institute For Medical Research, Inc

🇺🇸

Decatur, Georgia, United States

In-Quest Medical Research, Llc

🇺🇸

Duluth, Georgia, United States

Alta Pharmaceutical Research Center, Inc.

🇺🇸

Dunwoody, Georgia, United States

North Georgia Medical Research

🇺🇸

Ellijay, Georgia, United States

Well Star Cardiovascular Medicine, Pc

🇺🇸

Marietta, Georgia, United States

Mercer University School Of Medicine

🇺🇸

Macon, Georgia, United States

Southern Heart Research Institute, Llc

🇺🇸

Riverdale, Georgia, United States

Memorial Hospital Of Carbondale

🇺🇸

Carbondale, Illinois, United States

Northwestern University

🇺🇸

Chicago, Illinois, United States

Rush University Medical Center

🇺🇸

Chicago, Illinois, United States

University Of Chicago Hospitals

🇺🇸

Chicago, Illinois, United States

Clinical Investigation Specialists, Inc

🇺🇸

Gurnee, Illinois, United States

Midwest Heart Foundation

🇺🇸

Lombard, Illinois, United States

Illinois Heart & Lung Research

🇺🇸

Normal, Illinois, United States

Heartcare Midwest

🇺🇸

Peoria, Illinois, United States

Elkhart Clinic, Llc

🇺🇸

Elkhart, Indiana, United States

St Margaret Mercy Healthcare Centers

🇺🇸

Hammond, Indiana, United States

Medical Consultants, Pc

🇺🇸

Muncie, Indiana, United States

Iowa Heart Center

🇺🇸

West Des Moines, Iowa, United States

Mcfarland Clinic Pc

🇺🇸

Ames, Iowa, United States

Kentucky Heart & Vascular Physicians

🇺🇸

Ashland, Kentucky, United States

Research Integrity, Llc

🇺🇸

Owensboro, Kentucky, United States

Alexandria Cardiology Clinic

🇺🇸

Alexandria, Louisiana, United States

Clinical Research Network

🇺🇸

Alexandria, Louisiana, United States

Louisiana State University Health Sciences Center-Shreveport

🇺🇸

Shreveport, Louisiana, United States

Overton Brooks V.A.M.C.

🇺🇸

Shreveport, Louisiana, United States

Louisiana Heart Center

🇺🇸

Slidell, Louisiana, United States

Peninsula Cardiology Associates, P.A.

🇺🇸

Salisbury, Maryland, United States

Thoracic And Cardiovascular Healthcare Foundation

🇺🇸

Lansing, Michigan, United States

Endeavor Medical Research, Plc

🇺🇸

Alpena, Michigan, United States

Genesys Regional Medical Center

🇺🇸

Grand Blanc, Michigan, United States

Great Lakes Heart & Vascular Institute, Pc

🇺🇸

St. Joseph, Michigan, United States

St Cloud Hospital

🇺🇸

St. Cloud, Minnesota, United States

Bryanlgh Heart Institute

🇺🇸

Lincoln, Nebraska, United States

University Of Mississippi Medical Center

🇺🇸

Jackson, Mississippi, United States

Gateway Cardiology, P.C.

🇺🇸

St. Louis, Missouri, United States

Missouri Cardiovascular Specialists

🇺🇸

Columbia, Missouri, United States

Hamilton Cardiology Associates

🇺🇸

Hamilton, New Jersey, United States

The Valley Hospital

🇺🇸

Ridgewood, New Jersey, United States

Central New Jersey Cardiology

🇺🇸

South Plainfield, New Jersey, United States

Buffalo General Hospital

🇺🇸

Buffalo, New York, United States

Dr. Michael Sacher

🇺🇸

Massapequa, New York, United States

New York Methodist Hospital

🇺🇸

Brooklyn, New York, United States

Hudson Valley Heart Center

🇺🇸

Poughkeepsie, New York, United States

Asheville Cardiology Associates

🇺🇸

Asheville, North Carolina, United States

Wake Med Heart Center

🇺🇸

Raleigh, North Carolina, United States

Azalea Research Center

🇺🇸

Wilmington, North Carolina, United States

East Carolina Heart Institute At East Carolina University

🇺🇸

Greenville, North Carolina, United States

Wilmington Medical Research

🇺🇸

Wilmington, North Carolina, United States

Otfried N. Niedermaier, Md

🇺🇸

Akron, Ohio, United States

City Cardiology Associates

🇺🇸

Barberton, Ohio, United States

Fairfield Cardiac Cath Lab, Llc

🇺🇸

Fairfield, Ohio, United States

Genoa Medical Center

🇺🇸

Genoa, Ohio, United States

Middletown Cardiovascular Associates

🇺🇸

Middletown, Ohio, United States

Toledo Cardiology Consultants

🇺🇸

Toledo, Ohio, United States

Cardiology Associates Of Southeastern Ohio

🇺🇸

Zanesville, Ohio, United States

Blue Stem Cardiology

🇺🇸

Bartlesville, Oklahoma, United States

St. Charles Health System, Inc.

🇺🇸

Bend, Oregon, United States

St. Lukes Cardiology Associates

🇺🇸

Bethlehem, Pennsylvania, United States

Consultants In Cardiovascular Diseases, Inc.

🇺🇸

Erie, Pennsylvania, United States

Hamot Medical Center

🇺🇸

Erie, Pennsylvania, United States

Richard M. Kastelic M.D. & Associates, P.C.

🇺🇸

Johnstown, Pennsylvania, United States

The Heart Group

🇺🇸

Lancaster, Pennsylvania, United States

Drexel University College Of Medicine

🇺🇸

Philadelphia, Pennsylvania, United States

Penn Presbyterian Medical Center

🇺🇸

Philadelphia, Pennsylvania, United States

Pennsylvania Cardiology Associates

🇺🇸

Philadelphia, Pennsylvania, United States

Va Pittsburgh Healthcare System

🇺🇸

Pittsburgh, Pennsylvania, United States

Pottstown Medical Specialists, Inc

🇺🇸

Pottstown, Pennsylvania, United States

Buxmont Cardiology Associates, Pc

🇺🇸

Sellersville, Pennsylvania, United States

The Miriam Hospital

🇺🇸

Providence, Rhode Island, United States

Moffit Heart & Vascular Group

🇺🇸

Wormleysburg, Pennsylvania, United States

Anmed Health

🇺🇸

Anderson, South Carolina, United States

Cardiology Assoicates, Pc/Black Hills Clinical Research Ctr

🇺🇸

Rapid City, South Dakota, United States

Columbia Cardiology

🇺🇸

Columbia, South Carolina, United States

North Central Heart Institute

🇺🇸

Sioux Falls, South Dakota, United States

The Chattanooga Heart Institute

🇺🇸

Chattanooga, Tennessee, United States

The Stern Cardiovascular Center, Pa

🇺🇸

Germantown, Tennessee, United States

Research Associates Of Jackson

🇺🇸

Jackson, Tennessee, United States

Knoxville Heart Group

🇺🇸

Knoxville, Tennessee, United States

Mountain State Health Alliance

🇺🇸

Johnson City, Tennessee, United States

Amarillo Heart Clinical Research Institute Inc.

🇺🇸

Amarillo, Texas, United States

Dallas Va Medical Center

🇺🇸

Dallas, Texas, United States

Cardiovascular Research Institute Of Dallas

🇺🇸

Dallas, Texas, United States

Heart Consultants Of North Texas

🇺🇸

Dallas, Texas, United States

Texas Health Research & Education Institute

🇺🇸

Fort Worth, Texas, United States

T&R Clinic

🇺🇸

Fort Worth, Texas, United States

Heart Care Center

🇺🇸

Houston, Texas, United States

Centex Research, Pineloch Medical Clinic

🇺🇸

Houston, Texas, United States

Northwest Houston Cardiology, Pa

🇺🇸

Houston, Texas, United States

Texas Cardiac Center

🇺🇸

Lubbock, Texas, United States

Northwest Heart Center

🇺🇸

Tomball, Texas, United States

Scott&White Memorial Hospital

🇺🇸

Temple, Texas, United States

Sugarland Cardiology Associates

🇺🇸

Sugarland, Texas, United States

Tyler Cardiovascular Consultants

🇺🇸

Tyler, Texas, United States

Bermisa Family Practice & Research Center

🇺🇸

Chesapeake, Virginia, United States

Utah Cardiology P.C

🇺🇸

Layton, Utah, United States

Zakhary, Bosh

🇺🇸

Danville, Virginia, United States

Heart Care Associates P.C.

🇺🇸

Hopewell, Virginia, United States

The Cardiology Group Centra.

🇺🇸

Lynchburg, Virginia, United States

Sendara Cardiovasular Research Institute

🇺🇸

Norfolk, Virginia, United States

Virginia Cardiolovascular Associates

🇺🇸

Manassas, Virginia, United States

Inland Cardiology Associates

🇺🇸

Spokane, Washington, United States

Franciscan Research Center

🇺🇸

Tacoma, Washington, United States

Glenn J. Barquet, Md

🇺🇸

Miami, Florida, United States

Advanced Pharma Clinical Research

🇺🇸

Miami, Florida, United States

Krannertt Institute Of Cardiology

🇺🇸

Indianapolis, Indiana, United States

Miami Cardiology Clinical Research, L.L.C.

🇺🇸

Miami, Florida, United States

R. L.Roudebush Va Medical Center

🇺🇸

Indianapolis, Indiana, United States

The Care Group, Llc

🇺🇸

Indianapolis, Indiana, United States

Cincinnati Veterans Affairs Medical Center

🇺🇸

Cincinnati, Ohio, United States

Hennepin County Medical Center

🇺🇸

Minneapolis, Minnesota, United States

Va Medical Center

🇺🇸

Minneapolis, Minnesota, United States

University Of Minnesota, Medical School

🇺🇸

Minneapolis, Minnesota, United States

Duke University Medical Center

🇺🇸

Durham, North Carolina, United States

Central Cardiovascular Institute Of San Antonio

🇺🇸

San Antonio, Texas, United States

Jose A. Perez, M.D.

🇺🇸

San Antonio, Texas, United States

S.A.M. Clinical Research Center

🇺🇸

San Antonio, Texas, United States

Midwest Cardiology Associates , P.C.

🇺🇸

Overland Park, Kansas, United States

North Phoenix Heart Center

🇺🇸

Phoenix, Arizona, United States

Henry Ford Hospital

🇺🇸

Detroit, Michigan, United States

Cor Clinical Research, Llc

🇺🇸

Oklahoma City, Oklahoma, United States

University Of Oklahoma Health Sciences Center

🇺🇸

Oklahoma City, Oklahoma, United States

Oklahoma Cardiovascular Associates

🇺🇸

Oklahoma City, Oklahoma, United States

Access Clinical Trials

🇺🇸

Nashville, Tennessee, United States

Uab Medical Center

🇺🇸

Birmingham, Alabama, United States

University Of Alabama At Birmingham

🇺🇸

Birmingham, Alabama, United States

Heart Consultants

🇺🇸

Omaha, Nebraska, United States

Alegent Health Clinic Heart & Vascular Specialists

🇺🇸

Omaha, Nebraska, United States

Portland Preventive Cardiology, L.L.C.

🇺🇸

Portland, Oregon, United States

Wheaton Franciscan Healthcare St. Joseph

🇺🇸

Milwaukee, Wisconsin, United States

Dr Kiran C Patel Research Institute At Pepin Heart Hospital

🇺🇸

Tampa, Florida, United States

Covenant Medical Center, Inc

🇺🇸

Saginaw, Michigan, United States

Florida Heart Group

🇺🇸

Orlando, Florida, United States

Orlando Heart Center

🇺🇸

Orlando, Florida, United States

Cardiovascular Associates, Psc

🇺🇸

Louisville, Kentucky, United States

The University Of North Carolina At Chapel Hill

🇺🇸

Chapel Hill, North Carolina, United States

Tulane University Hospital And Clinic

🇺🇸

New Orleans, Louisiana, United States

Virgina Commonwealth Universitymedical Center

🇺🇸

Richmond, Virginia, United States

Dean And St. Mary'S Outpatient Center

🇺🇸

Madison, Wisconsin, United States

Blair Medical Associates, Inc.

🇺🇸

Altoona, Pennsylvania, United States

Northeast Georgia Heart Cntr, Pc

🇺🇸

Gainesville, Georgia, United States

Beaver Medical Group

🇺🇸

Banning, California, United States

Gateway Cardiology. P.C

🇺🇸

Jerseyville, Illinois, United States

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