Post-Myocardial Infarction Remodeling Prevention Therapy

Study Overview
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Brief Summary
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The purpose of this study is to demonstrate the feasibility of pacing as a therapy to prevent adverse remodeling of the myocardium following an acute myocardial infarction (MI) in patients at highest risk for adverse myocardial remodeling.

Official Title
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Post-Myocardial Infarction Remodeling Prevention Therapy

Conditions
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Acute Myocardial Infarction, Pacing Therapy, Cardiac Remodeling, Heart Failure

Intervention / Treatment
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* Device: Single Site Pacing
* Device: Dual Site Pacing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Myocardial Infarction (MI) within the past 10 days Peak Creatine Phosphokinase (CPK) greater than 3000 Units/Litre (U/L) at time of MI, or a troponin T (TnT) greater than 10 micrograms/Litre (mcg/L) At least 18 years old Willing to comply with the protocol Exclusion Criteria: Documented MI greater than 10 days Chronic renal disease, as defined by estimated glomerular filtration rate (eGFR) less than 30 milliliters/minute/1.73 square meter Life expectancy less than 18 months, as determined by a physician Existing pacemaker, Implantable Cardioverter Defibrillator (ICD), or Cardiac Resynchronization Therapy (CRT) device QRS duration greater than 120 milliseconds (ms) Coronary Artery Bypass Graft (CABG) within 30 days prior to MI, or CABG procedure planned Third degree atrioventricular (AV) block or symptomatic bradyarrhythmia Persistent atrial fibrillation (AF) that is not self terminating within 7 days or is terminated electrically or pharmacologically Permanent AF that is non self terminating, with cardioversion failed or not attempted within the past year New York Heart Association (NYHA) Class IV Non-ischemic cardiomyopathy Pregnant or planning to become pregnant during the study Enrolled or planning to participate in a concurrent drug and/or device study during the course of this clinical trial. Co-enrollment in concurrent trials is only allowed with documented pre-approval from Medtronic, documenting that there is not a concern that co-enrollment could confound the results of this trial. Breast feeding Of a vulnerable population as determined by local law or requirement, or a physician

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Single Site Pacing<br> | Device: Single Site Pacing<br>* Subjects will be implanted with a CRT-D that delivers pacing via the Left Ventricular lead.<br>|
| Experimental: Dual Site Pacing<br> | Device: Dual Site Pacing<br>* Subjects will be implanted with a CRT-D that delivers pacing via the Left Ventricular and Right Ventricular lead.<br>|
| No Intervention: Control<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Left Ventricular End Diastolic Volume (LVEDV) | Left ventricular end diastolic volume (LVEDV) was measured by echocardiogram. Change was measured as Month 18 LVEDV minus baseline LVEDV. Per protocol, change in LVEDV is compared between Pooled Pacing (Single site + Dual Site) and Control. | Baseline - 18 Month Follow Up Visit | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Safety of Implanting a Cardiac Resynchronization Therapy With Defibrillator (CRT-D) Device Within 10 Days of Myocardial Infarction (MI), as Measured by the Rate of Reported Adverse Events | Survival estimates at 18 months post-implant for time to first following events: (a) System Related Adverse Event (b) System Related Complication (c) Procedure Related Adverse Event (d) Procedure Related Complication and (e) System Related or Procedure Related Complication. | 18 months post-implant | 
| Frequency of Hospitalization for Cardiovascular Events | Number of hospitalizations related to cardiovascular events. | Baseline - 18 Month Follow Up Visit | 
| Change in New York Heart Association (NYHA) Functional Class | The New York Heart Association (NYHA) score classifies patients' heart failure according to the severity of their symptoms. In particular, Class I: No limitation of physical activity. Class II: Slight limitation of physical activity. Class III: Marked limitation of physical activity. Class IV: Unable to carry on any physical activity without discomfort. NYHA change from baseline to 18-month visit. If a subject improved by one NYHA class or more (e.g. NYHA IV to NYHA II, or NYHA III to NYHA I, etc) from the baseline visit, the subject was classified as Improved. Similarly for Worsened (e.g. subject does not have heart failure to NYHA I, NYHA I to NYHA II, etc.). If the subjects' NYHA Class is not different than baseline, then the subject was classified as No Change. Per protocol, change in NYHA is compared between Pooled Pacing (Single site + Dual Site) and Control. | Baseline - 18 Month Follow Up Visit | 
| Change in 6-minute Walk Test Distance | Change in 6-minute hallwalk distance from 1-month visit to the 18-month visit. Change is defined as month 18 minus baseline. Per protocol, change in 6-minute walk test distance is compared between Pooled Pacing (Single site + Dual Site) and Control. | 1 Month - 18 Month Follow Up Visit | 
| Change in Quality of Life | Change in the Minnesota Living with Heart Failure (MNLWHF) questionnaire from baseline to the 18-month follow-up visit. Change is defined as month 18 minus baseline. Per protocol change in MNLWHF is compared between Pooled Pacing (Dual Site + Single Site) and Control. | Baseline - 18 Month Follow Up Visit | 
| Incidence of Sudden Cardiac Death and Total Mortality | Mortality rates (%) for the events (a) all-cause death and (b) sudden-cardiac death at 18 months post randomization. Calculated using Kaplan-Meier methods. Per protocol the comparison of mortality rates is between Pooled Pacing (Dual Site + Single Site) and Control. | 18 Months post-randomization | 
| Linear Association Between Change in LVEDV and Selected Clinical Characteristics; Including Peak Creatinine Phosphokinase (CPK), Peak Troponin, Lead Location, Time From MI Onset to Implant, and Change in LV Volumes. | Linear association between change in LVEDV from baseline to 18-month visit (i.e. ΔLVEDV) and the following clinical characteristics were assessed: age, days from MI to implant, gender, hypertension, hyperlipidemia, diabetes, peak CPK, infarct location, LV electrode in acceptable place, and baseline LVEF. In order to assess these linear associations, linear regression models were fitted for each of these clinical characteristics (separately). In particular, each linear regression model had baseline LVEDV and the clinical characteristic as covariates, and ΔLVEDV was the response variable. Variables resulting in statistical significant (p<0.05) are reported. | Baseline - 18 Month Follow Up Visit |