Ticagrelor Versus Clopidogrel in Left Ventricular Remodeling After ST-segment Elevation Myocardial Infarction
- Registration Number
- NCT02224534
- Lead Sponsor
- Gyeongsang National University Hospital
- Brief Summary
The purpose of the study is to evaluate the novel role of ticagrelor to improve long-term LV remodeling following ST-segment elevation myocardial infarction.
- Detailed Description
The investigators designed the HEALING-AMI study to compare the influence of ticagrelor (180 mg loading and 90 mg twice daily maintenance) vs. clopidogrel (600 mg loading and 75 mg daily maintenance) on long-term left ventricular (LV) remodeling measured by 3D echocardiography in STEMI patients undergoing primary PCI.
The primary objective of the HEALING-AMI study is to demonstrate the novel role of long-term ticagrelor therapy in reducing the risk of LV remodeling,. The secondary objectives are to reveal the cross-talk between platelet and inflammatory process in ST-segment elevation myocardial infarction (STEMI) patients. Moreover, this study will determine whether the high platelet inhibition by ticagrelor culminate the protection of infarcted myocardium.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 326
- 18 years and older.
- First-time onset STEMI patients uneventfully treated with primary PCI within 12 hours of onset of symptom.
- Infarct-related artery with TIMI 0, 1, or 2 grade flow at the time of initial diagnostic angiography (before wire passage).
- proximal or mid-portion lesion of epicardial coronary artery.
- Previous history of myocardial infarction.
- Left bundle branch block on ECG at the time of screening.
- Cardiogenic shock at the time of randomization.
- Refractory ventricular arrhythmias or atrial fibrillation.
- New York Heart Association class IV congestive heart failure.
- Severe or malignant hypertension (SBP> 180 and/or DBP> 120 mmHg).
- Fibrinolytic therapy.
- History of hemorrhagic stroke.
- Intracranial neoplasm, arteriovenous malformation, or aneurysm.
- Ischemic stroke within 3 months prior to screening.
- Platelet count < 100,000/mm3 or hemoglobin < 10 g/dL.
- A need for oral anticoagulation therapy that cannot be safely discontinued for the duration of the study.
- Women who are known to be pregnant, have given birth within the past 90 days, or are breast-feeding.
- Unable to cooperate with protocol requirements and follow-up procedures.
- A history of P2Y12 receptor inhibitor pretreatment (at least prior 1 month).
- An increased risk of bradycardia.
- Concomitant therapy with a strong cytochrome P-450 3A inhibitor or inducer.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Ticagrelor and Clopidogrel. Ticagrelor The patients assigned to the TICA group have loading dose of ticagrelor 180 mg just after the randomization, and then ticagrelor 90 mg twice daily during the study period. All patients also have aspirin 300 mg as a loading dose and 100 mg once daily as a maintenance dose. Clopidogrel Clopidogrel The patients assigned to the CLPD group have loading dose of clopidogrel 600 mg just after the randomization, and then clopidogrel 75 mg daily should be maintained during the study period. All patients also have aspirin 300 mg as a loading dose and 100 mg once daily as a maintenance dose.
- Primary Outcome Measures
Name Time Method LV remodeling index (%) Interval change between baseline and 6 months after the index events Real time 3D-echocardiography data sets will be analyzed with available 4D-LV Analysis software (e.g. TomTec Imaging Systems, Unterschleisheim, Germany) in the core lab.
Left ventricular (LV) remodeling index: a relative change in LV end-diastolic volume (LVEDV) seen at 6-month follow-up compared with the baseline during admission.NT-proBNP level at 6 months 6 months after the index events
- Secondary Outcome Measures
Name Time Method Absolute change of LVESVI, LVEDVI and LVEF Interval change between baseline and 6 months after the index events Prevalence of adverse LV remodeling Interval change between baseline and 6 months after the index events Adverse LV remodeling: a relative \> 20% increase in LVEDV seen at 6-month follow-up compared with the baseline during admission.
Level of platelet reactivity At the time of PCI, 3 days and 1 month after the events Measured by VerifyNow P2Y12 assay
Trial Locations
- Locations (12)
Chonnam National University Hospital
🇰🇷Gwangju, CHONRANAM-Do, Korea, Republic of
National University Heart Centre
🇸🇬Singapore, Singapore
Pusan National University Yangsan Hospital
🇰🇷Yangsan, Korea, Republic of
Chinese PLA General Hospital
🇨🇳Bejing, China
Kyungpook National University Hospital
🇰🇷Daegu, Korea, Republic of
Kyung Hee University Hospital
🇰🇷Seoul, Korea, Republic of
Ulsan University Hospital
🇰🇷Ulsan, Korea, Republic of
Changwon Samsung Medical Center
🇰🇷Changwon, Korea, Republic of
Chungbuk National University Hospital
🇰🇷Chungju, Korea, Republic of
Chungnam National University Hospital
🇰🇷Daejeon, Korea, Republic of
Seoul National University Bundang Hospital
🇰🇷Bundang, Gyeongki-do, Korea, Republic of
Gyeongsang National University Hospital
🇰🇷Korea, Korea, Republic of