The INFUSE - Anterior Myocardial Infarction (AMI) Study

Not Applicable

Completed

• Conditions: Acute Anterior Myocardial Infarction
• Interventions: Drug: Abciximab local infusion; Other: No local infusion; Procedure: Thrombus aspiration

• Registration Number: NCT00976521
• Lead Sponsor: Atrium Medical Corporation

Brief Summary

This is a multicenter, open-label, controlled, single-blind, randomized study with up to 452 subjects enrolled in up to 50 US and European sites. Subjects who present with anterior ST-elevation myocardial infarction (STEMI) and an occluded proximal or mid left anterior descending (LAD) with TIMI 0/1/2 flow will be eligible for randomization to one of the following arms:

1. Local infusion of abciximab following thrombus aspiration

2. Local infusion of abciximab and no thrombus aspiration

3. No local infusion and thrombus aspiration

4. No local infusion and no thrombus aspiration

In addition, a cardiac magnetic resonance imaging (MRI) sub-study evaluating microvascular obstruction (MVO) will be performed with up to 160 subjects at up to 20 sites.

Detailed Description

The primary objective of the study is to demonstrate that among subjects undergoing primary PCI for anterior STEMI treated with a bivalirudin monotherapy anticoagulation strategy, the intracoronary infusion of an abciximab bolus with or without thrombus aspiration prior to stent implantation, compared to no infusion with or without thrombus aspiration (standard of care), results in 1) reduced infarct size measured by cardiac MRI at 30 days (range -7 days/+14 days; i.e., between 23 and 44 days), 2) reduce microvascular obstruction (MVO) by cardiac MRI at 5 + 2 days (i.e., between 3 and 7 days), 3) enhanced ST-segment resolution, 4) improved myocardial perfusion, 5) reduced thrombus burden and angiographic complications, and 6) no increase in major and minor bleeding.

Study Timeline

• Study Start: 2009-09
• Study First Submitted: 2009-09-11
• Study First Submitted QC: 2009-09-11
• Study First Posted: 2009-09-14
• Primary Completion: 2012-02
• Study Completion: 2013-04
• Results First Submitted: 2013-04-12
• Status Verified: 2013-05
• Results First Submitted QC: 2013-05-31
• Last Update Submitted: 2013-05-31
• Results First Posted: 2013-07-08
• Last Update Posted: 2013-07-08

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 452

Inclusion Criteria

• The subject must be >18 years of age;
• Subject is experiencing clinical symptoms consistent with AMI (e.g., chest pain, arm pain, etc.,) >30 minutes duration and unresponsive to nitroglycerin;
• Anterior MI with ECG showing at least 1 mm of ST-segment elevation in 2 or more contiguous leads in V1-V4, or new (or presumably new) left bundle branch block;
• Anticipated symptom onset to balloon or aspiration time of ≤5 hours;
• The subject and his/her physician are willing to comply with specified follow-up evaluations;
• The subject or legally authorized representative has been informed of the nature of the study, agrees to its provisions and has been provided and signed written informed consent, approved by the appropriate Medical Ethics Committee (MEC) or Institutional Review Board (IRB)
• Infarct artery located in the proximal or mid left anterior descending coronary artery, with TIMI 0/1/2 flow at the time of initial diagnostic angiography (prior to wire passage);
• Based on coronary anatomy, PCI is indicated for revascularization;
• Only one epicardial coronary artery will be treated;
• Expected ability to deliver a ClearWay™ RX Infusion Catheter to the infarct lesion (absence of excessive tortuosity, diffuse disease or moderate/heavy calcification).

Key

Exclusion Criteria

• Prior myocardial infarction, or known prior systolic dysfunction (known ejection fraction <40% by any prior measure or regional wall motion abnormalities);
• An elective surgical procedure is planned that would necessitate interruption of anti-platelet agents during the first twelve months post enrollment;
• Subjects who previously underwent coronary stent implantation and in whom coronary angiography demonstrates stent thrombosis to be the cause of the AMI;
• Subject has previously undergone an angioplasty or stenting procedure in the left anterior descending artery;
• Definite planned use of aspiration, atherectomy, thrombectomy and/or distal protection catheters prior to PTCA or stent implantation (other than in subjects randomized to thrombus aspiration);
• Any contraindication to undergo MRI imaging.
• Multivessel intervention required during the index procedure (subjects may be enrolled if treatment of more than one lesion in the LAD or its branches is required, however) (planned staged procedures are permitted with strong recommendation to be performed after 30-day clinical and MRI endpoints are completed);
• Severe vessel tortuosity, diffuse disease or severe calcification is present which may impede successful delivery of the ClearWay™ RX Infusion Catheter or the Export® Aspiration Catheter;
• Features are present highly unfavorable for PCI;
• Target lesion is present within a bypass graft conduit;
• MI is due to thrombosis within or adjacent to a previously implanted stent;
• Left ventriculography demonstrates severe mitral regurgitation or a VSD;
• Unprotected left main stenosis >40% or that will require intervention

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
Local infusion, no aspiration	Abciximab local infusion	Local infusion of abciximab using the ClearWay™ RX Infusion Catheter and no aspiration
No local infusion, no aspiration	No local infusion	No local infusion abciximab and no thrombus aspiration
Local infusion, thrombus aspiration	Abciximab local infusion	Local infusion of abciximab using the ClearWay™ RX Infusion Catheter following thrombus aspiration.
Local infusion, thrombus aspiration	Thrombus aspiration	Local infusion of abciximab using the ClearWay™ RX Infusion Catheter following thrombus aspiration.
No local infusion, thrombus aspiration	No local infusion	No local infusion of abciximab, thrombus aspiration.
No local infusion, thrombus aspiration	Thrombus aspiration	No local infusion of abciximab, thrombus aspiration.

Primary Outcome Measures

Name	Time	Method
Primary Endpoint - Infarct Size at 30 Days as a Percentage of Total Left Ventricular Mass - Abciximab Infusion vs. No Infusion	30 Days Post Index Procedure	The primary endpoint of the INFUSE AMI study is infarct size as a percentage of total left ventricular mass at 30 days as measured by cardiac MRI (cMRI), comparing the pooled randomized active (abciximab) infusion to the pooled non infusion arms, without regard to aspiration.

Secondary Outcome Measures

Name	Time	Method
Major Secondary Endpoint - Infarct Size at 30 Days as a Percentage of Total Left Ventricular Mass - Aspiration vs. No Aspiration	30 Days	The major secondary endpoint of the INFUSE AMI Study is infarct size as a percentage of total myocardial mass at 30 days measured by cardiac MRI (cMRI), comparing the pooled randomized aspiration arms to the pooled no aspiration arms, without regard to abciximab infusion.

Trial Locations

Locations (38)

Washington Adventist Hospital; 🇺🇸 Takoma Park, Maryland, United States

Carolinas Medical Center-SHVI; 🇺🇸 Charlotte, North Carolina, United States

Moses Cone Vascular Center; 🇺🇸 Greensboro, North Carolina, United States

Geisinger Medical Center; 🇺🇸 Danville, Pennsylvania, United States

Harrisburg Hospital/ Pinnacle Health; 🇺🇸 Harrisburg, Pennsylvania, United States

Wellmont Holston Valley Medical Center; 🇺🇸 Kingsport, Tennessee, United States

Sentara Virginia Beach General Hospital; 🇺🇸 Virginia Beach, Virginia, United States

Landeskrankenhaus Braunau/Simbach; 🇦🇹 Braunau, Austria

Landeskrankenhaus Bruck/Mur; 🇦🇹 Bruck/Mur, Austria

Landeskrankenhaus Graz West; 🇦🇹 Graz, Austria

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