Effect of Platelet Inhibition and / or Lipid Lowering in Non-ACS-patients With Positive Troponin
- Conditions
- Acute Chest Syndrome
- Interventions
- Registration Number
- NCT03820466
- Lead Sponsor
- Dr. med. Mahir Karakas
- Brief Summary
The study evaluates the effect of platelet inhibition and / or lipid lowering in non-ACS-patients with symptoms suggestive for ACS, and elevated high-sensitivity troponin values
- Detailed Description
Current databases show, that high-/ ultra sensitive (hs)/ (us) troponin levels above the 99th percentile in patients presenting with chest pain are indicative for future cardiovascular events, even when acute coronary syndrome (ACS) was ruled out. Most of these non-ACS-patients are discharged without specific/ preventive therapy (anti-platelet or anti-lipid), although "positive" troponin values (any value at any time during hospitalisation above the 99th percentile) seem to clearly indicate underlying myocardial ischemia. In summary, there is an unmet need and huge potential to reduce mortality and morbidity in Chest Pain Unit patients by specific therapy. The investigators propose that platelet inhibition by Aspirin or lipid lowering by Atorvastatin will prevent plaque rupture and superimposition of thrombosis to coronary atherosclerosis in this population. It is planned to conduct a controlled clinical trial: 3,000 troponin positive patients presenting at emergency room (ER)/ CPU with symptoms suggestive for ACS, but an ACS was ruled out, will be assigned randomly to Aspirin 100 mg and/ or Atorvastatin 20 mg versus placebo (2x2 factorial design).
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 68
- Patient with symptoms suggestive for ACS presenting within 48 hours after onset in the ER/ Chest Pain Unit (CPU)
- Patient has at least one elevated high-sensitivity troponin I or T value
- Chest pain is classified as non-ACS, despite elevated hsTn (e.g. because of missing troponin dynamics)
- At least 50 years of age
- Indication for antiplatelet therapy (e.g transient ischemic attack, or stable coronary artery diseases -CAD) or anticoagulation therapy (such as atrial fibrillation)
- Indication for anti-lipid therapy
- Any evidence of an acute myocardial necrosis (e.g imaging evidence of new regional wall motion abnormality, or significant ST-segment-T wave (ST-T) changes in ECG)
- Untreated clinically significant CAD requiring revascularization
- Hemoglobin value below 8 mg/d, and/or creatinine kinase ≥3 times ULN, and/or AST or ALT ≥3 times ULN
- Active malignancy of any organ system, treated or untreated. Subjects have to be in remission for at least 36 months to be eligible.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Atorvastatin Atorvastatin Atorvastatin 20 mg once daily and Placebo Aspirin once daily Aspirin Placebo Atorvastatin Aspirin 100 mg once daily and Placebo Atorvastatin once daily Aspirin-Atorvastatin Atorvastatin Aspirin 100 mg once daily and Atorvastatin 20 mg once daily Placebo Placebo Aspirin Placebo Aspirin once daily and Placebo Atorvastatin once daily Placebo Placebo Atorvastatin Placebo Aspirin once daily and Placebo Atorvastatin once daily Atorvastatin Placebo Aspirin Atorvastatin 20 mg once daily and Placebo Aspirin once daily Aspirin Aspirin Aspirin 100 mg once daily and Placebo Atorvastatin once daily Aspirin-Atorvastatin Aspirin Aspirin 100 mg once daily and Atorvastatin 20 mg once daily
- Primary Outcome Measures
Name Time Method Myocardial infarction and/ or cardiovascular death and/ or revascularization Until last patient has completed 12 months of follow-up Time to myocardial infarction, coronary revascularization, or death, whatever comes first
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (7)
University of Berlin, Campus Benjamin-Franklin
🇩🇪Berlin, Germany
Asklepios Harz-Hospital Goslar
🇩🇪Goslar, Germany
University Heart Center Hamburg
🇩🇪Hamburg, Germany
University of Heidelberg
🇩🇪Heidelberg, Germany
University of Leipzig
🇩🇪Leipzig, Germany
Robert-Bosch-Hospital Stuttgart
🇩🇪Stuttgart, Germany
University of Ulm
🇩🇪Ulm, Germany
University of Berlin, Campus Benjamin-Franklin🇩🇪Berlin, Germany