Coronary Bifurcation Lesions Treated With Biguard Stent System

Nanjing First Hospital, Nanjing Medical University

Overview

This study is designed to test the hypothesis that the Biguard stent system will lead to fewer target lesion failure compared to regular stent system in patients with coronary bifurcation lesions at one year.

The current study is designed as a multicenter, randomized and prospective study aiming to compare the effect of Biguard bifurcation stent system and regular stent system in patients with bifurcation lesions. Based on the previous studies, the rate of 1-year target lesion failure was around 12% after PCI with regular stent system. And the investigators previous data showed that this event at 12-month after Biguard bifurcation stent system was 4%. Considering the lost to follow-up, it is anticipated that up to 400 patients will be enrolled in the trial. All patients will have repeat angiography at 13 months, with clinical follow-up to 2 years.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Conditions

Coronary Artery Disease

Interventions

Biguard sirolimus-eluting bifurcation stent systemDEVICE

PCI with Biguard sirolimus-eluting bifurcation stent system

Sirolimus-eluting stent systemDEVICE

PCI with sirolimus-eluting stent system

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Subject must be age≥18 years; * Subject (or legal guardian) understands the trial requirements and the treatment procedures and provides written informed consent before any trial-specific tests or procedures are performed; * Subject is eligible for percutaneous coronary intervention (PCI); * Subject has symptomatic coronary artery disease or documented silent ischemia; * Subject is willing to comply with all protocol-required follow-up evaluations; * Target lesion must be a de novo true bifurcation lesions located in a native coronary artery with a visually estimated reference vessel diameter (RVD) ≥2.50 mm and ≤4.00 mm; * Target lesion must have visually estimated stenosis ≥50%; * The lesion length of main branch vessel must measure \<40 mm, and the lesion length of side branch vessel must measure \<20 mm (by visual estimate); * Subject with no more than one lesion existing in the same vessel can be chosen, when several bifurcation lesions existing simultaneously; * Subject with knowledge of trial purpose, informed consents and volition of undergoing coronary angiography and clinical follow-up voluntarily. Exclusion Criteria: * Subject has clinical symptoms and/or electrocardiogram (ECG) changes consistent with acute MI within two weeks; * Subject is on dialysis or has serum creatinine level \>3.0 mg/dL; * Subject has known allergy to the study stent system or protocol-required concomitant medications; * Subject has any other serious medical illness that may reduce life expectancy to less than 12 months; Patient with cardiac heart failure (above New York Heart Association (classification) III), or left ventricular ejection fraction (LVEF)\< 30%; * Subject with hemorrhagic tendency or history of active peptic ulcers, cerebral hemorrhage, or subarachnoid hemorrhage, cerebral stroke within half a year, as well as patients who have contraindication to anti-platelet agents or anticoagulant treatment; * Subject is participating in another investigational drug or device clinical trial that has not reached its primary endpoint or intends to participate in another investigational drug or device clinical trial within 12 months after the index procedure; * Subject Inability to follow the protocol and comply with follow-up requirements or any other reason that the investigator feels would place the patient at increased risk- Subject has more than 1 lesion that requires treatment during the index procedure; * Target lesion meets any of the following criteria: 1. Thrombus, or possible thrombus, present in the target vessel; 2. Excessive tortuosity proximal to or within the lesion; 3. Excessive angulation proximal to or within the lesion; 4. Chronic total occlusion lesion in target vessel not re-canalized; 5. severe calcification with unsuccessfully pre-dilated; 6. restenosis disease.

Outcomes

Primary Outcomes

Incidence of Ischemia Driven Target Lesion Failure (ID-TLF)

The number of participants with adverse events that are related to treatment. Adverse events included cardiac death (death in which a cardiac cause cannot be excluded), Myocardial infarction (MI, classified as Q-wave and non-Q wave), Ischemia-driven target lesion revascularization (TLR) by CABG or PCI and Ischemia-driven target vessel revascularization (TVR) by CABG or PCI.

Time frame: 12 months

Secondary Outcomes

In-stent late lumen loss in millimeter

In-stent MLD post-procedure minus in-stent MLD at follow-up (in-stent defined as within the margins of the stent)

Time frame: 13 months

Proximal Late Loss in millimeter

Proximal Minimum Lumen Diameter (MLD) post-procedure minus proximal MLD at follow-up (proximal defined as within 5 mm of healthy tissue proximal to stent placement)

Time frame: 13 months

Distal Late Loss in millimeter

Distal MLD post-procedure minus distal MLD at follow-up (distal defined as within 5 mm of healthy tissue distal to stent placement)

Time frame: 13 months

Incidence of Target Vessel Failure (TVF)

Time frame: 30 days

Incidence of Target Vessel Failure (TVF)

Data from ClinicalTrials.gov

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Incidence of Target Vessel Failure (TVF)

Time frame: 3 year

Incidence of Target Vessel Failure (TVF)

Time frame: 5 year

Incidence of Ischemia Driven Target Lesion Revascularization (ID-TLR)

The number of participants with revascularization at target lesion associated with any of following: functional ischemia study Ischemic symptoms \& angiographic diameter stenosis ≥50% by core lab quantitative coronary angiography (QCA), revascularization of a target lesion with angiographic diameter stenosis ≥70% by core laboratory QCA without angina or functional study.

Time frame: 30 days

Incidence of Ischemia Driven Target Lesion Revascularization (ID-TLR)

Time frame: 1 year

Incidence of Ischemia Driven Target Lesion Revascularization (ID-TLR)

Time frame: 3 year

Incidence of Ischemia Driven Target Lesion Revascularization (ID-TLR)

Time frame: 5 year

Incidence of Ischemia Driven Target Vessel Revascularization (ID-TVR)

The number of participants with revascularization at the target vessel associated with any of the following Positive functional ischemia study Ischemic symptoms and angiographic diameter stenosis ≥ 50% by core laboratory QCA Revascularization of a target vessel with angiographic diameter stenosis ≥ 70% by core laboratory QCA without angina or positive functional study Derived from Non-Hierarchical Subject Counts of Adverse Events

Time frame: 30 days

Incidence of Ischemia Driven Target Vessel Revascularization (ID-TVR)

Time frame: 1 year

Incidence of Ischemia Driven Target Vessel Revascularization (ID-TVR)

Time frame: 3 year

Incidence of Ischemia Driven Target Vessel Revascularization (ID-TVR)

Time frame: 5 year

Incidence of Ischemia Driven Major Adverse Cardiac Event (MACE)

The number of participants with adverse events that are related to treatment. Adverse events comprised of cardiac death, Myocardial infarction (MI, classified as Q-wave and non-Q wave), Ischemia-driven target lesion revascularization (TLR) by CABG or PCI.

Time frame: 30 days

Incidence of Ischemia Driven Major Adverse Cardiac Event (MACE)

Time frame: 1 year

Incidence of Ischemia Driven Major Adverse Cardiac Event (MACE)

Time frame: 3 year

Incidence of Ischemia Driven Major Adverse Cardiac Event (MACE)

Time frame: 5 year

In-stent % Angiographic Binary Restenosis (% ABR) Rate

Percent of subjects with a follow-up in-stent percent diameter stenosis of ≥ 50% per quantitative coronary angiography (QCA)

Time frame: 13 months

In-segment % Angiographic Binary Restenosis (% ABR) Rate

Percent of subjects with a follow-up in-segment percent diameter stenosis of ≥ 50% per quantitative coronary angiography (QCA)

Time frame: 13 months