Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis - SAfety & EffectiveneSS of Drug-ElUting Stents & Anti-platelet REgimen

Study Overview
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Brief Summary
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Objectives To compare the safety and long-term effectiveness of coronary stenting with the new platform Everolimus-Eluting coronary stenting system (EECSS, Promus Element) compared with the Zotarolimus-Eluting coronary stenting system (ZECSS, Endeavor Resolute) in patients with coronary heart disease (CHD) To determine the short-term efficacy and safety of triple anti-platelet therapy (TAT, Aspirin 100mg qd, Clopidogrel 75mg qd and Cilostazol 100mg bid) compared with double-dose clopidogrel dual anti-platelet therapy (DDAT, Aspirin 100mg qd and Clopidogrel 150mg qd) in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) Study design Prospective, open-label, 2-by-2 multifactorial, randomized, multicenter trial to test the following in CHD patients Non-inferiority of Promus Element stent compared with Endeavor Resolute stent in reducing target lesion failure (TLF) Non-inferiority of TAT compared with DDAT in reducing net clinical outcome Patients will be randomized in a 2-by-2 factorial manner according to the type of drug eluting stent (EECSS vs. ZECSS) and the type anti-platelet regimen (TAT vs. DDAT). Randomization will also be stratified per presence of DM. Patient enrollment 3750 patients enrolled at 50 centers in Republic of Korea Patient follow-up Clinical follow-up will occur at 1, 3, 12, 24, 36 months after the procedure. Angiographical follow-up will be recommended to all participants at 13 months after the procedure. Investigator or designee may conduct follow-up as telephone contacts or office visits. Primary endpoint Target lesion failure (TLF), defined as a composite of cardiac death, target vessel-related myocardial infarction (MI) and ischemia-driven target lesion revascularization (TLR) up to 12 months for the stent arm Net clinical outcome, defined as a composite of cardiac death, nonfatal MI, CVA and major bleeding by PLATO criteria at 1 month for the anti-platelet arm

Detailed Description
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Secondary endpoint Clinical and laboratory endpoint at 1 month All death and cardiac death Myocardial infarction (q wave and non-q wave) Stent thrombosis (definite and possible) CVA (hemorrhagic and non-hemorrhagic) Bleeding (major and minor) VerifyNow ASA and VerifyNow P2Y12 Clinical endpoint at 12 months All death and cardiac death Target vessel-related MI and all MI (q wave and non-q wave) Target vessel/lesion revascularization (ischemia-driven and all) Stent thrombosis (definite/possible/probable) Net clinical outcome including bleeding (major and minor) Acute success of procedure (device, lesion and procedure) Angiographic (including IVUS or OCT) endpoint at 13 months In-stent & In-segment late loss In-stent & In-segment % diameter stenosis Angiographic pattern of restenosis Neointimal volume, % neointimal volume and % volume obstruction on IVUS or OCT Degree of stent strut endothelialization on OCT

Official Title
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Comparison of the Efficacy and Safety of New Platform Everolimus-eluting Coronary Stent System (Promus Element) With Zotarolimus-eluting Coronary Stent System (Endeavor Resolute) and Triple Anti-platelet Therapy With Double-dose Clopidogrel Anti-platelet Therapy in Patients With Coronary Heart Disease

Conditions
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Coronary Heart Disease

Intervention / Treatment
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* Device: Everolimus-eluting coronary stenting system (EECSS, Promus Element)
* Device: Zotarolimus-eluting coronary stenting system (ZECSS, Endeavor Resolute)
* Drug: Triple anti-platelet therapy (TAT)
* Drug: Double-dose clopidogrel anti-platelet therapy (DDAT)


Participation Criteria
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Eligibility Criteria
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General Inclusion Criteria Subject must be at least 18 years of age. Subject is able to verbally confirm understandings of risks, benefits and treatment alternatives of receiving the Promus Element or Endeavor Resolute stents, and he/she or his/her legally authorized representative provides written informed consent prior to any study related procedure. Subject must have significant lesion (>50% by visual estimate) in any of the coronary arteries, venous or arterial bypass grafts. Subject must have evidence of myocardial ischemia (e.g., stable, unstable angina, recent infarction, silent ischemia, positive functional study or a reversible changes in the electrocardiogram (ECG) consistent with ischemia). In subjects with diameter stenosis > 70%, evidence of myocardial ischemia does not have to be documented. Angiographic Inclusion Criteria Target lesion(s) must be located in coronary artery, venous or arterial bypass graft with diameter of ≥ 2.5 mm and ≤ 4.00 mm. Target lesion(s) must be amenable for percutaneous coronary intervention. Exclusion criteria The patient has a known hypersensitivity or contraindication to any of the following medications: Heparin, Aspirin, Clopidogrel, Cilostazol, Everolimus, Zotarolimus, Contrast media (Patients with documented sensitivity to contrast media which can be effectively premedicated with steroids and diphenhydramine [e.g. rash] may be enrolled. Those with true anaphylaxis to prior contrast media, however, should not be enrolled.) Systemic (intravenous) Everolimus or Zotarolimus use within 12 months. Female of childbearing potential, unless a recent pregnancy test is negative, who possibly plan to become pregnant any time after enrollment into this study. History of bleeding diathesis, known coagulopathy (including heparin-induced thrombocytopenia), abnormal hemogram (Hb<10g/dL or PLT count <100,000/μL) or will refuse blood transfusions Patients with severe LV systolic dysfunction (LVEF<25%) or cardiogenic shock Gastrointestinal or genitourinary bleeding within the prior 3 months, or major surgery within 2 months. Non-cardiac co-morbid conditions are present with life expectancy <1 year or that may result in protocol non-compliance (per site investigator's medical judgment). Patients who are actively participating in another drug or device investigational study, which have not completed the primary endpoint follow-up period. Symptomatic heart failure

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: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: EECSS + DDAT<br>Promus Element stent + double-dose clopidogrel anti-platelet therapy | Device: Everolimus-eluting coronary stenting system (EECSS, Promus Element)<br>* Everolimus-eluting stent<br>* Other names: Promus Element;Drug: Double-dose clopidogrel anti-platelet therapy (DDAT)<br>* 100mg Aspirin QD + 150mg Clopidogrel QD for 1 month<br>|
| Active Comparator: ZECSS + DDAT<br>Endeavor Resolute stent + double-dose clopidogrel anti-platelet therapy | Device: Zotarolimus-eluting coronary stenting system (ZECSS, Endeavor Resolute)<br>* Zotarolimus-eluting stent<br>* Other names: Endeavor Resolute;Drug: Double-dose clopidogrel anti-platelet therapy (DDAT)<br>* 100mg Aspirin QD + 150mg Clopidogrel QD for 1 month<br>|
| Experimental: EECSS + TAT<br>Promus Element stent + triple anti-platelet therapy | Device: Everolimus-eluting coronary stenting system (EECSS, Promus Element)<br>* Everolimus-eluting stent<br>* Other names: Promus Element;Drug: Triple anti-platelet therapy (TAT)<br>* 100mg Aspirin QD + 75mg Clopidogrel QD + 100mg Cilostazol BID for 1 month<br>|
| Active Comparator: ZECSS + TAT<br>Endeavor Resolute stent + triple anti-platele therapy | Device: Zotarolimus-eluting coronary stenting system (ZECSS, Endeavor Resolute)<br>* Zotarolimus-eluting stent<br>* Other names: Endeavor Resolute;Drug: Triple anti-platelet therapy (TAT)<br>* 100mg Aspirin QD + 75mg Clopidogrel QD + 100mg Cilostazol BID for 1 month<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Target lesion failure (TLF) | Composite of cardiac death, target vessel-related myocardial infarction (MI) and ischemia-driven target lesion revascularization (TLR) | 12 months | 
| Net clinical outcome | Composite of cardiac death, nonfatal MI, CVA and major bleeding by PLATO criteria | 1 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Everolimus, Zotarolimus, Cilostazol, Clopidogrel