Randomized, controlled, blind, single-center and non-inferiority clinical trial to compare the target lesion failure (TLF) at 12 months in patients with diabetes mellitus who underwent percutaneous coronary intervention with an Orsiro stent vs. Abluminus stent.
Worldwide, and especially in Mexico, there is a high incidence of diabetes mellitus (DM), which in turn, confers a higher cardiovascular risk in this population. Diabetic patients undergoing PCI have worse outcomes than non-diabetics regardless of the degree of complexity of their coronary anatomy. Although the 30-day in-hospital outcomes have been similar between diabetic and non-diabetic patients, DM has been invariably associated with greater stent failure with target vessel revascularization (TVR), major adverse cardiovascular event (MACE), and mortality in the long-term follow-up, even with the use of drug-eluting stents. In relation to the above, two of the sirolimus-eluting stents (SES): the Abluminus and the Orsiro, have been considered as promising options in patients with DM. The Abluminus stent has been designed for diabetic patients in order to reduce cardiovascular events. Said stent consists of a cobalt-chromium platform covered with a layer of biodegradable polymer and mounted on a balloon, both sirolimus-releasing. The Rate of target lesion failure (TLF) reported to date in diabetic patients is 3.8%. On the other hand, the Orsiro stent, a cobalt-chromium platform with ultrathin struts, has had favorable results in different clinical settings and patients with different characteristics\]; specifically in a subgroup analysis in DM, a TLF rate of 3.5% was reported
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
860
The procedure will be conducted in accordance with the CE mark instructions for use for the ASES. The need or not for postdilation in any segment of the stent will be at the discretion of the operator, seeking its adequate expansion and apposition. To consider PCI to be successful, residual stenosis must be less than or equal to 30% by angiography at the end of the procedure, including the absence of coronary dissection that compromises distal flow or a hemodynamically significant pressure gradient across the lesion.
The procedure will be conducted in accordance with the CE mark instructions for use for the OSES. The need or not for postdilation in any segment of the stent will be at the discretion of the operator, seeking its adequate expansion and apposition. To consider PCI to be successful, residual stenosis must be less than or equal to 30% by angiography at the end of the procedure, including the absence of coronary dissection that compromises distal flow or a hemodynamically significant pressure gradient across the lesion.
Instituto Nacional de Cardiología Ignacio Chávez
Mexico City, Tlalpan, Mexico
RECRUITINGRate of Target Lesion Failure (TLF)
To compare the rate of target lesion failure (composed of cardiovascular death, myocardial infarction related to the treated vessel or ischemia driven target lesion revascularization)
Time frame: 12 months
Cardiovascular Death
Cardiovascular death is defined as death resulting from cardiovascular causes. The following categories may be collected: * Death caused by acute MI * Death caused by sudden cardiac, including unwitnessed, death * Death resulting from heart failure * Death caused by stroke * Death caused by cardiovascular procedures * Death resulting from cardiovascular hemorrhage * Death resulting from other cardiovascular cause * Any MI not clearly attributable to a non-target vessel will be considered as target-vessel MI. * Percutaneous coronary intervention (PCI) related MI is termed type 4a MI. * Coronary artery bypass grafting (CABG) related MI is termed type 5 MI. Revascularization is clinically driven if the target lesion diameter stenosis is \> 50% by quantitative coronary angiography (QCA) and the subject has clinical or functional ischemia which cannot be explained by another native coronary or bypass graft lesion.
Time frame: 12 months
Myocardial Infarction (MI)
Compare the myocardial infarction related to the treated vessel between both groups. (according to the 4th international definition of myocardial infarction) detection of an increase or decrease in cardiac troponin values with at least 1 of the values above the upper reference limit of the 99th percentile and at least 1 of the following conditions : * Symptoms of acute myocardial ischemia. * New ischemic changes in the electrocardiogram. * Appearance of pathological Q waves. * Imaging evidence of loss of viable myocardium or new regional abnormalities in myocardial wall mobility following a pattern compatible with ischemic etiology. * Identification of a coronary thrombus by angiography with intracoronary imaging or by autopsy * Any MI that cannot be clearly attributed to a vessel other than the revascularized one will be considered as MI related to the treated vessel.
Time frame: 12 months
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Target Lesion Revascularization (TLR)
Revascularization is clinically driven if the target lesion diameter stenosis is \> 50% by quantitative coronary angiography (QCA) and the subject has clinical or functional ischemia which cannot be explained by another native coronary or bypass graft lesion.
Time frame: 12 months
Target vessel revascularization (TVR)
TVR is a repeat percutaneous intervention of the target lesion or bypass surgery of the target vessel performed for restenosis or other complication of the target lesion.
Time frame: 12 months
Target vessel failure (TVF)
To compare the rate of target vessel failure (composed of cardiovascular death, myocardial infarction related to the treated vessel or ischemia driven target vessel revascularization)
Time frame: 12 months
Death caused by other cardiovascular causes.
Compare death from any cause between the two groups. The following categories will be collected: * Malignancy. * Pulmonary causes. * Infection. * Gastrointestinal causes. * Accident / trauma. * Caused by failure of another non-cardiovascular organ. * Other non-cardiovascular causes. * Death that cannot be attributed to any of the aforementioned categories due to lack of information will be considered cardiovascular in terms of study outcomes.
Time frame: 12 months
Rate of in-stent restenosis (ISR)
Compare the rate of stent edge restenosis between both groups. Stenosis\> 50% of the diameter and one or more of the following: symptoms suggestive of ischemia, electrocardiographic changes suggestive of ischemia, significant pressure gradient across the lesion; or a\> 70% reduction in luminal area, even in the absence of data suggestive of ischemia. The categories will be collected according to the Waksman In-Stent Restenosis Classification: * Type I: mechanical * IA Underexpansion * IIA Stent fracture * Type II: Biologic * IIA Intimal hyperplasia * IIB Neoatherosclerosis, noncalcified * IIC Neoatherosclerosis, calcified * Type III: Mixed pattern: Combined mechanical and biologic etiology * Type IV: Chronic total occlusion * Type V: \>2 layers of stent
Time frame: 12 months
Rate of stent thrombosis (ST)
Compare the rate of stent thrombosis between both groups, According to the definition of the Academic Research Consortium (ARC) -2: 1. Definitive thrombosis. 2. Probable thrombosis. 3. Silent occlusion. 4. Temporality: acute (0-24 hours), subacute (\> 24 hours to 30 days), late (\> 30 days to 1 year) and very late (\> 1 year).
Time frame: 12 months
Major bleeding
Compare the incidence of bleeding complications according to The Bleeding Academic Research Consortium 2 (BARC-2) scale: 3 or greater.
Time frame: 12 months
Rate of Cerebrovascular Event
Compare the rate of cerebrovascular event between both groups according to Neuro-ARC stroke/ Transient ischemic attack (TIA) criteria.
Time frame: 12 months
Contrast Nephropathy
Creatinine increase \>0.5 mg / dl or \>25% over baseline at 48 hours after the procedure.
Time frame: 48 hours
Technical Success
Technical success is defined as the ability to cross the occluded segment with both a wire and a balloon, and successfully open the artery; the restoration of antegrade Thrombolysis In Myocardial Infarction (TIMI) flow 2 or 3 and a \<30% residual stenosis.
Time frame: 12 months