PROMUS Element Plus US Post-Approval Study
- Conditions
- Coronary Artery Disease
- Interventions
- Registration Number
- NCT01589978
- Lead Sponsor
- Boston Scientific Corporation
- Brief Summary
This study is designed to observe clinical outcomes in patients receiving the PROMUS Element Plus Everolimus-Eluting Platinum Chromium Coronary Stent System in routine clinical practice. Patients will have symptomatic heart disease or documented silent ischemia. This is a prospective, open-label consecutively-enrolling study. Clinical follow-up is through 5 years. Approximately 2,689 patients are to be enrolled in up to 65 centers in the United States.
- Detailed Description
The wide-spread use of drug-eluting stents (DES) has evolved as standard of care in de novo lesions. The PROMUS Element Plus Everolimus-Eluting Platinum Chromium Coronary Stent System is indicated for improving luminal diameter in patients with symptomatic heart disease or documented silent ischemia due to de novo lesions in native coronary arteries ≥2.25 mm to ≤4.00 mm in diameter in lesions ≤34 mm in length. The proposed study will compile real-world clinical outcomes data for the PROMUS Element Plus Everolimus-Eluting Platinum Chromium Coronary Stent System in routine clinical practice.
Patients enrolled in this study are expected to follow antiplatelet therapy recommendations per American College of Cardiology (ACC)/American Heart Association (AHA)/Society for Cardiovascular Angiography and Interventions (SCAI) guidelines for percutaneous coronary intervention (PCI). Recommended medications include aspirin, which should be taken for 3 days prior to the procedure or as a peri-procedural loading dose and then continued indefinitely. Additionally, one of the following P2Y12 antagonists may be given in a peri-procedural loading dose and in a maintenance dose per physician discretion: clopidogrel, prasugrel, ticagrelor, or ticlopidine.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 2681
- The population will include consecutive, consented patients.
- There are no exclusion criteria in this all-comers study.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description PROMUS Element PROMUS Element Plus Coronary Stent System Subjects who receive the PROMUS Element everolimus-eluting coronary stent PROMUS Element P2Y12 antagonist Subjects who receive the PROMUS Element everolimus-eluting coronary stent PROMUS Element Aspirin Subjects who receive the PROMUS Element everolimus-eluting coronary stent
- Primary Outcome Measures
Name Time Method Cardiac Death or Myocardial Infarction Rate in PLATINUM-like Patients 12 months Cardiac death or myocardial infarction rate at 12 months post implantation in PLATINUM-like patients (no acute myocardial infarction, graft stenting, chronic total occlusion, in-stent restenosis, failed brachytherapy, bifurcation, ostial lesion, severe tortuosity, moderate/severe calcification, 3-vessel stenting, cardiogenic shock, left main disease, or acute/chronic renal dysfunction; lesion length ≤28 mm with reference vessel diameter ≥2.25 mm and \<2.5 mm, or lesion length ≤24 mm with diameter ≥2.5 mm and ≤4.25 mm); statistical testing will assess if rate meets the performance goal (3.2%)
- Secondary Outcome Measures
Name Time Method All Death Rate ≤24 hours, 30 days, 180 days, annually through 5 years All death includes cardiac death and non-cardiac death.
Definite + Probable Stent Thrombosis (ST) Rate Based on Academic Research Consortium (ARC) Definition in PLATINUM-like Patients 12 months ARC definite/probable ST rate in PLATINUM-like patients (no acute myocardial infarction, graft stenting, chronic total occlusion, in-stent restenosis, failed brachytherapy, bifurcation, ostial lesion, severe tortuosity, moderate/severe calcification, 3-vessel stenting, cardiogenic shock, left main disease, or acute/chronic renal dysfunction; lesion length ≤28 mm with reference vessel diameter ≥2.25 mm and \<2.5 mm, or lesion length ≤24 mm with diameter ≥2.5 mm and ≤4.25 mm); statistical testing will assess if the annual ST rate increase after the first year meets the performance goal (1.0%)
Definite + Probable Stent Thrombosis (ST) Rate Based on Academic Research Consortium (ARC) Definition in All Patients ≤24 hours, 30 days, 180 days, annually through 5 years DEFINITE ST: acute coronary syndrome and angiographic or pathologic evidence of stent thrombosis; PROBABLE ST: unexplained death within 30 days or target-vessel infarction without angiographic information ARC ST is reported as a cumulative value at different time points and within the different separate time points. Time 0 is the time point after the guide catheter has been removed. Acute ST: 0-24 hours after stent implantation; Subacute ST: \>24 hours to 30 days post; late ST: \>30 days to 1 year post; Very late ST: \>1 year post; NOTE: Acute/subacute can be replaced by early ST (0-30 days)
Rate of Longitudinal Stent Deformation Index Procedure Compression/elongation of a stent along its long axis resulting from interaction with an ancillary device (e.g., guide catheter) which catches the stent end or an internal stent strut; can occur with advancement or withdrawal of ancillary device. Under fluoroscopy, longitudinal compression usually results in increased strut density and elongation in decreased strut density ('pseudo-fracture'); both can occur in the same stent.
Rate of Major Adverse Cardiac Events Related to the PROMUS Element Stent ≤24 hours, 30 days, 180 days, annually through 5 years Composite of cardiac death, myocardial infarction, and target vessel revascularization related to the PROMUS Element stent
Myocardial Infarction (MI) Rate ≤24 hours, 30 days, 180 days, annually through 5 years New Q-waves in ≥2 leads lasting ≥0.04 sec with creatine kinase myoglobin band(CK-MB) or troponin \>upper limit of normal(ULN); if no new Q-waves total CK levels \>3×ULN (peri-percutaneous coronary intervention \[PCI\]) or \>2×ULN (spontaneous) with elevated CK-MB or troponin \>3×ULN (peri-PCI) or \>2×ULN (spontaneous) plus ≥one of the following: ECG changes indicating new ischemia (new ST-T changes, left bundle branch block), imaging evidence of new loss of viable myocardium, new regional wall motion abnormality. Similar for MI diagnosis post coronary artery bypass graft with CK-MB or troponin \>5×ULN
Major Adverse Cardiac Event Rate (MACE) ≤24 hours, 30 days, 180 days, annually through 5 years Composite of cardiac death, myocardial infarction, and target vessel revascularization
Rate of Myocardial Infarction (MI) Events Related to the PROMUS Element Stent ≤24 hours, 30 days, 180 days, annually through 5 years New Q-waves in ≥2 leads lasting ≥0.04 sec with creatine kinase myoglobin band(CK-MB) or troponin \>upper limit of normal(ULN); if no new Q-waves total CK levels \>3×ULN (peri-percutaneous coronary intervention \[PCI\]) or \>2×ULN (spontaneous) with elevated CK-MB or troponin \>3×ULN (peri-PCI) or \>2×ULN (spontaneous) plus ≥one of the following: ECG changes indicating new ischemia (new ST-T changes, left bundle branch block), imaging evidence of new loss of viable myocardium, new regional wall motion abnormality. Similar for MI diagnosis post coronary artery bypass graft with CK-MB or troponin \>5×ULN
Cardiac Death Rate ≤24 hours, 30 days, 180 days, annually through 5 years Cardiac death is defined as death due to any of the following: acute myocardial infarction; cardiac perforation/pericardial tamponade; arrhythmia or conduction abnormality; cerebrovascular accident through hospital discharge or cerebrovascular accident suspected of being related to the procedure; death due to complication of the procedure, including bleeding, vascular repair, transfusion reaction, or bypass surgery; any death in which a cardiac cause cannot be excluded
Rate of Cardiac Death Events Related to the PROMUS Element Stent ≤24 hours, 30 days, 180 days, annually through 5 years Cardiac death is defined as death due to any of the following: acute myocardial infarction; cardiac perforation/pericardial tamponade; arrhythmia or conduction abnormality; cerebrovascular accident through hospital discharge or cerebrovascular accident suspected of being related to the procedure; death due to complication of the procedure, including bleeding, vascular repair, transfusion reaction, or bypass surgery; any death in which a cardiac cause cannot be excluded
Target Vessel Revascularization (TVR) Rate ≤24 hours, 30 days, 180 days, annually through 5 years Target vessel revascularization is defined as any attempted or successfully completed percutaneous or surgical revascularization of a target vessel.
Rate of Target Vessel Revascularization (TVR) Events Related to the PROMUS Element Stent ≤24 hours, 30 days, 180 days, annually through 5 years Target vessel revascularization is defined as any attempted or successfully completed percutaneous or surgical revascularization of a target vessel.
Cardiac Death or Myocardial Infarction (MI) Rate ≤24 hours, 30 days, 180 days, annually through 5 years See individual descriptions of events.
Rate of Cardiac Death or Myocardial Infarction Events Related to the PROMUS Element Stent ≤24 hours, 30 days, 180 days, annually through 5 years See individual descriptions of events.
Target Vessel Failure (TVF) Rate ≤24 hours, 30 days, 180 days, annually through 5 years Target vessel failure (TVF) is defined as any revascularization of the target vessel, myocardial infarction (MI) related to the target vessel, or death related to the target vessel.
For the purposes of this protocol, if it cannot be determined with certainty whether MI or death was related to the target vessel it will be considered TVF.Rate of Target Vessel Failure (TVF) Related to the PROMUS Element Stent ≤24 hours, 30 days, 180 days, annually through 5 years Target vessel failure (TVF) is defined as any revascularization of the target vessel, myocardial infarction (MI) related to the target vessel, or death related to the target vessel.
For the purposes of this protocol, if it cannot be determined with certainty whether MI or death was related to the target vessel it will be considered TVF.Non-cardiac Death Rate ≤24 hours, 30 days, 180 days, annually through 5 years Non-cardiac death is defined as death not due to cardiac causes.
Cardiac death is death due to any of the following: acute myocardial infarction; cardiac perforation/pericardial tamponade; arrhythmia or conduction abnormality; cerebrovascular accident through hospital discharge or cerebrovascular accident suspected of being related to the procedure; death due to complication of the procedure, including bleeding, vascular repair, transfusion reaction, or bypass surgery; any death in which a cardiac cause cannot be excluded.All Death or Myocardial Infarction Rate ≤24 hours, 30 days, 180 days, annually through 5 years See description of individual events.
Target Vessel Failure (TVF) Rate in PLATINUM-like Medically Treated Diabetic Patients 12 Months Any revascularization of the target vessel, myocardial infarction related to the target vessel, or death related to the target vessel. See individual components for descriptions. Statistical testing will determine if the rate meets the performance goal (12.6%)
ARC ST Rate in PLATINUM-like Population. Annually through 5 years Using the Academic Research Consortium (ARC) definition, the (definite/probable) stent thrombosis (ST) rate in the PLATINUM-like\* population will be analyzed. Statistical testing will be used to determine if the annual increase after the first year in ST rates observed in PLATINUM-like patients meets the performance goal of 1.0% (expected rate of 0.4% + a delta of 0.6%).
Trial Locations
- Locations (52)
Community Heart and Vascular Hospital
🇺🇸Indianapolis, Indiana, United States
North Memorial Medical Center
🇺🇸Minneapolis, Minnesota, United States
IU Health North Medical Center
🇺🇸Carmel, Indiana, United States
Cardiovascular Research, LLC
🇺🇸Shreveport, Louisiana, United States
Blessing Hospital
🇺🇸Quincy, Illinois, United States
Franciscan St. Francis Hospital
🇺🇸Indianapolis, Indiana, United States
St. John's Regional Health Center (Springfield)
🇺🇸Springfield, Missouri, United States
St. Francis Hospital
🇺🇸Tulsa, Oklahoma, United States
Eastern Maine Medical Center
🇺🇸Bangor, Maine, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
University Medical Center-Greenville Memorial Hospital
🇺🇸Greenville, South Carolina, United States
New York University Medical Center
🇺🇸New York, New York, United States
Rapid City Regional Hospital
🇺🇸Rapid City, South Dakota, United States
Avera Heart Hospital of South Dakota
🇺🇸Sioux Falls, South Dakota, United States
VA North Texas Health Care System
🇺🇸Dallas, Texas, United States
Huntsville Hospital - The Heart Center, PC
🇺🇸Huntsville, Alabama, United States
NEA Baptist Memorial Hospital
🇺🇸Jonesboro, Arkansas, United States
Springhill Medical Center
🇺🇸Mobile, Alabama, United States
St. Bernard's Medical Center
🇺🇸Jonesboro, Arkansas, United States
Loma Linda University Medical Center
🇺🇸Loma Linda, California, United States
Brandon Regional Hospital
🇺🇸Brandon, Florida, United States
Christiana Hospital
🇺🇸Newark, Delaware, United States
Memorial Regional Hospital
🇺🇸Hollywood, Florida, United States
Mount Sinai Medical Center
🇺🇸Miami Beach, Florida, United States
Bay Medical Center
🇺🇸Panama City, Florida, United States
Martin Memorial Health Systems - Martin Memorial Medical Center
🇺🇸Stuart, Florida, United States
Piedmont Hospital
🇺🇸Atlanta, Georgia, United States
Coliseum Medical Center
🇺🇸Macon, Georgia, United States
Redmond Regional Medical Center
🇺🇸Rome, Georgia, United States
Cape Cod Hospital
🇺🇸Hyannis, Massachusetts, United States
Novant Health Presbyterian Medical Center
🇺🇸Charlotte, North Carolina, United States
Grand Strand Regional Medical Center
🇺🇸Myrtle Beach, South Carolina, United States
St. Francis Health System - St. Francis Hospital
🇺🇸Greenville, South Carolina, United States
Presbyterian Hospital of Dallas
🇺🇸Dallas, Texas, United States
Marshfiled Clinic
🇺🇸Weston, Wisconsin, United States
Carilion Roanoke Memorial Hospital
🇺🇸Roanoke, Virginia, United States
Lakeland Hospitals at St. Joseph
🇺🇸Saint Joseph, Michigan, United States
Forest County General Hospital
🇺🇸Hattiesburg, Mississippi, United States
Presbyterian University of Pennsylvania Medical Center
🇺🇸Philadelphia, Pennsylvania, United States
United Hospital - St. Paul Heart Clinic
🇺🇸Saint Paul, Minnesota, United States
Cox Medical Centers
🇺🇸Springfield, Missouri, United States
Hackensack University Medical Center
🇺🇸Hackensack, New Jersey, United States
St. Elizabeth Medical Center
🇺🇸Utica, New York, United States
Doylestown Hospital
🇺🇸Doylestown, Pennsylvania, United States
University of Utah Hospital and Clinics
🇺🇸Salt Lake City, Utah, United States
Mercy General Hospital
🇺🇸Sacramento, California, United States
Orlando Regional Medical Center
🇺🇸Orlando, Florida, United States
North Florida Regional Medical Center
🇺🇸Gainesville, Florida, United States
St. Joseph Hospital
🇺🇸Lexington, Kentucky, United States
South Austin Hospital
🇺🇸Austin, Texas, United States
Chippenham Medical Center
🇺🇸Richmond, Virginia, United States
Meriter Hospital
🇺🇸Madison, Wisconsin, United States