SPIRIT PRIME Clinical Trial

Study Overview
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Brief Summary
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To evaluate the safety and effectiveness of the XIENCE PRIME and XIENCE PRIME Long Lesion (LL) Everolimus Eluting Coronary Stent System (EECSS) in improving coronary luminal diameter in subjects with symptomatic heart disease due to a maximum of two de novo native coronary artery lesions, each in a different epicardial vessel.

Official Title
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SPIRIT PRIME Clinical Trial.

Conditions
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Myocardial Ischemia, Coronary Artery Stenosis, Coronary Disease, Coronary Artery Disease, Coronary Restenosis

Intervention / Treatment
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* Device: Core size Xience Prime
* Device: Xience Prime Long Lesion (LL)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subject must be at least 18 years of age. Subject or a legally authorized representative must provide written informed consent prior to any study related procedure, per site requirements. Subject must have evidence of myocardial ischemia (e.g., stable or unstable angina, silent ischemia, positive functional study or a reversible change in the electrocardiogram (ECG) consistent with ischemia). Subject must be an acceptable candidate for coronary artery bypass graft (CABG) surgery. Subject must agree to undergo all protocol-required follow-up procedures. Subject must agree not to participate in any other clinical study for a period of one year following the index procedure. Angiographic Inclusion Criteria One or two de novo target lesions each in a different epicardial vessel. If there are two target lesions, both lesions must satisfy the angiographic eligibility criteria for that registry. o Multiple focal de novo lesions in a target vessel that can be covered by a single stent are allowed. The target lesion(s) must be located in a major artery or branch with a visually estimated diameter stenosis of ≥ 50% and < 100% with a TIMI flow of ≥ 1. Target lesion(s) must be located in a native coronary artery with reference vessel diameter (RVD) by visual estimation of: ≥ 2.25 mm and ≤ 4.25 mm for treatment by the core size XIENCE PRIME EECS ≥ 2.5 mm and ≤ 4.25 mm for treatment by the XIENCE PRIME LL EECS Target lesion(s) must be located in a native coronary artery with length by visual estimation of: ≤ 22 mm for treatment by the core size XIENCE PRIME EECS > 22 mm and ≤ 32 mm for treatment by the XIENCE PRIME LL EECS Exclusion Criteria: Subject has had a known diagnosis of acute myocardial infarction (AMI) preceding the index procedure (CK-MB ≥ 2 times upper limit of normal) and CK and CK-MB have not returned to within normal limits at the time of procedure. The subject is currently experiencing clinical symptoms consistent with new onset AMI, such as nitrate-unresponsive prolonged chest pain with ischemic ECG changes. Subject has current unstable cardiac arrhythmias associated with hemodynamic instability. Subject has a known left ventricular ejection fraction (LVEF) < 30% (LVEF may be obtained at the time of the index procedure if the value is unknown and if necessary). Subject has received coronary brachytherapy in any epicardial vessel (target or non target). Subject has received any organ transplant or is on a waiting list for any organ transplant. Subject is receiving or scheduled to receive chemotherapy for malignancy within 30 days prior to or within one year after the index procedure. Subject is receiving or scheduled to receive planned radiotherapy to the chest/mediastinum. Subject is receiving immunosuppressant therapy or has known immunosuppressive or autoimmune disease (e.g. human immunodeficiency virus, systemic lupus erythematosus etc.). Subject is receiving chronic anticoagulation therapy (e.g., heparin, coumadin). Subject will require Low Molecular Weight Heparin (LMWH) post-procedure. Subject has a known hypersensitivity or contraindication to aspirin, heparin/bivalirudin, clopidogrel/ticlopidine, everolimus, cobalt, chromium, nickel, tungsten, acrylic and fluoro polymers or contrast sensitivity that cannot be adequately pre-medicated. Elective surgery is planned within 12 months after the procedure that will require discontinuing either aspirin or clopidogrel. Subject has a platelet count < 100,000 cells/mm3 or > 700,000 cells/mm3, a white blood cell (WBC) of < 3,000 cells/mm3, or documented or suspected liver disease (including laboratory evidence of hepatitis). Subject has known renal insufficiency (examples being but not limited to estimated glomerular filtration rate (eGFR) < 60 ml/kg/m2, serum creatinine level ≥ 2.5 mg/dL, or on dialysis). Subject has a history of bleeding diathesis or coagulopathy or will refuse blood transfusions. Subject has had a cerebrovascular accident/stroke or transient ischemic neurological attack (TIA) within the past six months. Subject has had a significant gastro-intestinal or significant urinary bleed within the past six months. Subject has extensive peripheral vascular disease that precludes safe 6 French sheath insertion. Subject has other medical illness (e.g., cancer or congestive heart failure) or known history of substance abuse (alcohol, cocaine, heroin etc.) that may cause non-compliance with the protocol, confound the data interpretation or is associated with a limited life expectancy (i.e., less than one year). Subject is currently participating in another clinical study that has not yet completed its primary endpoint. Pregnant or nursing subjects and those who plan pregnancy in the period up to 1 year following index procedure. Female subjects of child-bearing potential must have a negative pregnancy test done within 7 days prior to the index procedure per site standard test. Angiographic Exclusion Criteria All angiographic exclusion criteria are based on visual estimation. Target lesion located within an arterial or saphenous vein graft or distal to a diseased (vessel irregularity per angiogram and > 20% stenosed lesion) arterial or saphenous vein graft. Target lesion involving a bifurcation with a side branch ≥ 2 mm in diameter and/or ostial lesion > 40% stenosed or side branch requiring protection guide wire, or side branch requiring dilatation. Target lesion with total occlusion (TIMI flow 0), prior to crossing with the wire. Another lesion requiring revascularization is located in the same epicardial vessel of the target lesion. Restenotic target lesion. Aorto-ostial target lesion (within 3 mm of the aorta junction). Target lesion is in a left main location. Target lesion located within 2 mm of the origin of the LAD or LCX. Extreme angulation (≥ 90 °) or excessive tortuosity (≥ two 45° angles) proximal to or within the lesion. Heavy calcification proximal to or within the target lesion. Target vessel contains thrombus as indicated in the angiographic images. Target lesion has a high probability that a procedure other than pre-dilatation and stenting will be required at the time of index procedure for treatment of the target vessel (e.g. atherectomy, cutting balloon). Target vessel is previously treated with any type of PCI (e.g. balloon angioplasty, stent, cutting balloon, atherectomy) < 9 months prior to index procedure. Non-target vessel is previously treated with any type of PCI < 90 days prior to the index procedure. Additional clinically significant lesion(s) (e.g. %DS ≥ 50%) in a target vessel or side branch for which PCI may be required < 90 days after the index procedure.

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: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Core size registry (CSR)<br>Core size indicates the range of diameters of the stents used. | Device: Core size Xience Prime<br>* Core size includes a range of stent sizes.<br>|
| Experimental: Long lesion registry (LLR)<br>Use of long lesion stents. | Device: Xience Prime Long Lesion (LL)<br>* Long lesion stent sizes include a range of sizes.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Target Lesion Failure (TLF) | The composite rate of: Cardiac Death Target Vessel Myocardial Infarction (TV-MI) and Clinically Indicated Target Lesion Revascularization (CI-TLR) per protocol. | 1 year | 
| Target Lesion Failure (TLF) | The composite rate of: Cardiac Death Target Vessel Myocardial Infarction (TV-MI) and Clinically Indicated Target Lesion Revascularization (CI-TLR) per protocol. | 2 years | 
| Target Lesion Failure (TLF) | The composite rate of: Cardiac Death Target Vessel Myocardial Infarction (TV-MI) and Clinically Indicated Target Lesion Revascularization (CI-TLR) per protocol. | 3 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Procedure Time | Procedure time is defined as time between insertion and withdrawal of guide catheter. | From insertion to withdrawal of guide catheter | 
| Device Success (Lesion Basis) | Device success is defined as achievement of a final in-stent residual diameter stenosis of < 50% (by QCA). | From the start of index procedure to end of index procedure | 
| Procedural Success (Subject Basis) | Procedure success is defined as achievement of a final in-stent diameter stenosis of < 50% (by QCA). Per Protocol. | From the start of index procedure to end of index procedure | 
| All Death (Cardiac, Vascular, Non-cardiovascular) |  | In-hospital is less than or equal to 7 days post index procedure | 
| All Death (Cardiac, Vascular, Non-cardiovascular) |  | 30 days | 
| All Death (Cardiac, Vascular, Non-cardiovascular) |  | 180 days | 
| All Death (Cardiac, Vascular, Non-cardiovascular) |  | 1 year | 
| All Death (Cardiac, Vascular, Non-cardiovascular) |  | 2 years | 
| All Death (Cardiac, Vascular, Non-cardiovascular) |  | 3 years | 
| Target Vessel-Myocardial Infarction (TV-MI) - Q-wave and Non Q-wave (Defined as MI Not Clearly Attributable to a Non-target Vessel) | Per Protocol | In-hospital is defined as hospitalization less than or equal to 7 days post index procedure. | 
| Target Vessel-Myocardial Infarction (TV-MI) - Q-wave and Non Q-wave (Defined as MI Not Clearly Attributable to a Non-target Vessel) | Per Protocol | 30 days | 
| Target Vessel-Myocardial Infarction (TV-MI) - Q-wave and Non Q-wave (Defined as MI Not Clearly Attributable to a Non-target Vessel) | Per Protocol | 180 days | 
| Target Vessel-Myocardial Infarction (TV-MI) - Q-wave and Non Q-wave (Defined as MI Not Clearly Attributable to a Non-target Vessel) | Per Protocol | 1 year | 
| Target Vessel-Myocardial Infarction (TV-MI) - Q-wave and Non Q-wave (Defined as MI Not Clearly Attributable to a Non-target Vessel) | Per Protocol | 2 years | 
| Target Vessel-Myocardial Infarction (TV-MI) - Q-wave and Non Q-wave (Defined as MI Not Clearly Attributable to a Non-target Vessel) | Per Protocol | 3 years | 
| Non-target Vessel MI (Q-wave, Non Q-wave) | Per Protocol | In-hospital is defined as hospitalization less than or equal to 7 days post index procedure | 
| Non-target Vessel MI (Q-wave, Non Q-wave) | Per Protocol | 30 days | 
| Non-target Vessel MI (Q-wave, Non Q-wave) | Per Protocol | 180 days | 
| Non-target Vessel MI (Q-wave, Non Q-wave) | Per Protocol | 1 year | 
| Non-target Vessel MI (Q-wave, Non Q-wave) | Per Protocol | 2 years | 
| Non-target Vessel MI (Q-wave, Non Q-wave) | Per Protocol | 3 years | 
| Clinically Indicated-Target Lesion Revascularization |  | In-hospital is defined as hospitalization less than or equal to 7 days post index procedure | 
| Clinically Indicated-Target Lesion Revascularization |  | 30 days | 
| Clinically Indicated-Target Lesion Revascularization |  | 180 days | 
| Clinically Indicated-Target Lesion Revascularization |  | 1 year | 
| Clinically Indicated-Target Lesion Revascularization |  | 2 years | 
| Clinically Indicated-Target Lesion Revascularization |  | 3 years | 
| Clinically Indicated Target Vessel Revascularization (TVR = TLR and Non-TLR in TV) |  | In-hospital is defined as hospitalization less than or equal to 7 days post index procedure | 
| Clinically Indicated Target Vessel Revascularization (TVR = TLR and Non-TLR in TV) |  | 30 days | 
| Clinically Indicated Target Vessel Revascularization (TVR = TLR and Non-TLR in TV) |  | 180 days | 
| Clinically Indicated Target Vessel Revascularization (TVR = TLR and Non-TLR in TV) |  | 1 year | 
| Clinically Indicated Target Vessel Revascularization (TVR = TLR and Non-TLR in TV) |  | 2 years | 
| Clinically Indicated Target Vessel Revascularization (TVR = TLR and Non-TLR in TV) |  | 3 years | 
| All TLR (CI and Non-CI) |  | In-hospital is defined as hospitalization less than or equal to 7 days post index procedure | 
| All TLR (CI and Non-CI) |  | 30 days | 
| All TLR (CI and Non-CI) |  | 180 days | 
| All TLR (CI and Non-CI) |  | 1 year | 
| All TLR (CI and Non-CI) |  | 2 years | 
| All TLR (CI and Non-CI) |  | 3 years | 
| All TVR (CI and Non-CI) |  | In-hospital is defined as hospitalization less than or equal to 7 days post index procedure | 
| All TVR (CI and Non-CI) |  | 30 days | 
| All TVR (CI and Non-CI) |  | 180 days | 
| All TVR (CI and Non-CI) |  | 1 year | 
| All TVR (CI and Non-CI) |  | 2 years | 
| All TVR (CI and Non-CI) |  | 3 years | 
| All Coronary Revascularization (TVR and Non-TVR) |  | In-hospital is defined as hospitalization less than or equal to 7 days post index procedure | 
| All Coronary Revascularization (TVR and Non-TVR) |  | 30 days | 
| All Coronary Revascularization (TVR and Non-TVR) |  | 180 days | 
| All Coronary Revascularization (TVR and Non-TVR) |  | 1 year | 
| All Coronary Revascularization (TVR and Non-TVR) |  | 2 years | 
| All Coronary Revascularization (TVR and Non-TVR) |  | 3 years | 
| Cardiac Death/All MI |  | In-hospital is defined as hospitalization less than or equal to 7 days post index procedure | 
| Cardiac Death/ All MI | Per Protocol | 30 days | 
| Cardiac Death/All MI | Per Protocol | 180 days | 
| Cardiac Death/All MI | Per Protocol | 1 year | 
| Cardiac Death/All MI | Per Protocol | 2 years | 
| Cardiac Death/All MI | Per Protocol | 3 years | 
| Cardiac Death/ All MI/CI-TLR |  | in-hospital | 
| Cardiac Death/ All MI/CI-TLR | Per Protocol | 30 days | 
| Cardiac Death/ All MI/CI-TLR | Per Protocol | 180 days | 
| Cardiac Death/ All MI/CI-TLR | Per Protocol | 1 year | 
| Cardiac Death/ All MI/CI-TLR | Per Protocol | 2 years | 
| Cardiac Death/ All MI/CI-TLR | Per Protocol | 3 years | 
| All Death/All MI/All Coronary Revascularization | Per Protocol | In-hospital is defined as hospitalization less than or equal to 7 days post index procedure | 
| All Death/All MI/All Coronary Revascularization | Per Protocol | 30 days | 
| All Death/All MI/All Coronary Revascularization | Per Protocol | 180 days | 
| All Death/All MI/All Coronary Revascularization | Per Protocol | 1 year | 
| All Death/All MI/All Coronary Revascularization | Per Protocol | 2 years | 
| All Death/All MI/All Coronary Revascularization | Per Protocol | 3 years | 
| Stent Thrombosis | Per protocol and per Academic Research Consortium (ARC, definite/probable) | Acute (≤1 day) | 
| Stent Thrombosis | Per protocol and per ARC | Subacute (>1 - 30 days) | 
| Stent Thrombosis | Per protocol and per ARC | Acute/Subacute (0 - 30 days) | 
| Stent Thrombosis | Per protocol and per ARC | Late (31 - 393 days) | 
| Stent Thrombosis | Per protocol | Late (31 - 758 days) | 
| Stent Thrombosis | Per ARC, definite and probable | Very Late (394 - 758 days) | 
| Stent Thrombosis | Per protocol | Late (31 - 1123 days) | 
| Stent Thrombosis | Per ARC, definite and probable | Very Late (394 - 1123 days) | 
| Stent Thrombosis | Per protocol and per ARC | Overall (0-393 days) | 
| Stent Thrombosis | Per protocol | Overall (0-758 days) | 
| Stent Thrombosis | Per ARC, definite and probable | Overall (0-758 days) | 
| Stent Thrombosis | Per protocol | Overall (0 - 1123 days) | 
| Stent Thrombosis | Per ARC, definite and probable | Overall (0 - 1123 days) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Coronary Disease, drug eluting stents, stents, Angioplasty, myocardial ischemia, coronary artery stenosis, Coronary Artery Disease, Coronary Restenosis, Long lesion