Clinical trial NCT03479723: Identification of Predictors for Coronary Plaque Erosion in Patients With Acute Coronary Syndrome
Official title: Identification of Predictors for Coronary Plaque Erosion in Patients With Acute Coronary Syndrome
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Acute Coronary Syndrome
Lead sponsor: Massachusetts General Hospital
Sponsor class: OTHER
First posted: 2018-03-27
Enrollment: 1793
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: CASE_ONLY
Time perspective: OTHER
Sampling method: PROBABILITY_SAMPLE
Study population: Patients with diagnosis of ACS confirmed by OCT imaging of the culprit lesion.

Brief summary: The purpose of this study is to perform pooled analysis with data collected from 5 previously published studies and 8 unpublished datasets collected from international sites. The main goal of this study is to identify the predictors of plaque erosion.

Detailed description: Plaque erosion is reported to be responsible for about one third of patients with acute coronary syndrome (ACS). In the EROSION study, we reported that antithrombotic therapy without stenting achieved a reduction in thrombus volume greater than 50% in over 70% of patients diagnosed with ACS caused by plaque erosion. This result suggests that the conservative approach of anti-thrombotic therapy without stenting may be an option for patients diagnosed with ACS caused by plaque erosion, which may be the paradigm shift in treatment of ACS patients. However, at present, the only way to make an in vivo diagnosis of plaque erosion is intra-coronary optical coherence tomography (OCT). If we can identify clinical factors associated with plaque erosion, we may be able to narrow down a sub-population of patients with a higher likelihood of plaque erosion. This group of patients may be stabilized with pharmacologic therapy and avoid invasive procedures, thereby preventing related complications and reducing health care burden. However, specific demographic characteristics of the ACS patients with plaque erosion are not known. Our group has the world's largest dataset of patients with plaque erosion and several published reports on plaque erosion. However, the study population of each study is still small and unbalanced to identify the demographic characteristics associated with plaque erosion. Therefore, we propose to pool data from a large number of institutions around the world. This will provide an opportunity to identify factors associated with plaque erosion.

Eligibility criteria: Inclusion Criteria:

1. Diagnosed with ACS upon admission to hospital, including patients with ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina pectoris (UAP).
2. Intra-vascular OCT imaging of culprit vessel.

Exclusion Criteria:

* None

Primary outcomes:
measure: Cardiac death
timeFrame: 3-year
Secondary outcomes:
measure: all cause death
timeFrame: 3-year
measure: myocardial infarction
timeFrame: 3-year
measure: stent thrombosis
timeFrame: 3-year
measure: any target lesion revascularization
timeFrame: 3-year
measure: clinically driven target lesion revascularization
timeFrame: 3-year
measure: target-vessel revascularization
timeFrame: 3-year
measure: any repeat revascularization
timeFrame: 3-year
measure: stroke
timeFrame: 3-year
measure: device-oriented composite (cardiac death, target vessel MI, and TLR)
timeFrame: 3-year
measure: bleeding complication
timeFrame: 3-year
measure: patients-oriented composite (all cause death, MI, any repeat coronary revascularization)
timeFrame: 3-year
measure: target vessel failure (TVF; cardiac death, MI, or ischemia-driven TVR)
timeFrame: 3-year
measure: major adverse cardiac events (MACEs: cardiac death, MI, or ischemia-driven TLR)
timeFrame: 3-year
Other outcomes:
Locations:
city: Boston
country: United States
facility: Massachusetts General Hospital
state: Massachusetts
Study officials:
affiliation: Massachusetts General Hospital
name: Ik-Kyung Jang, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Seegers LM, Araki M, Nakajima A, Yonetsu T, Minami Y, Ako J, Soeda T, Kurihara O, Higuma T, Kimura S, Adriaenssens T, Nef HM, Lee H, McNulty I, Sugiyama T, Kakuta T, Jang IK. Sex Differences in Culprit Plaque Characteristics Among Different Age Groups in Patients With Acute Coronary Syndromes. Circ Cardiovasc Interv. 2022 Jun;15(6):e011612. doi: 10.1161/CIRCINTERVENTIONS.121.011612. Epub 2022 Jun 2.
citation: Araki M, Yonetsu T, Kurihara O, Nakajima A, Lee H, Soeda T, Minami Y, Higuma T, Kimura S, Takano M, Yan BP, Adriaenssens T, Boeder NF, Nef HM, Kim CJ, McNulty I, Crea F, Kakuta T, Jang IK. Age and Phenotype of Patients With Plaque Erosion. J Am Heart Assoc. 2021 Oct 5;10(19):e020691. doi: 10.1161/JAHA.120.020691. Epub 2021 Sep 25.
citation: Nakajima A, Subban V, Russo M, Bryniarski KL, Kurihara O, Araki M, Minami Y, Soeda T, Yonetsu T, Crea F, Takano M, Higuma T, Kakuta T, Adriaenssens T, Boeder NF, Nef HM, Raffel OC, McNulty I, Lee H, Nakamura S, Abdullakutty J, Mathew R, Sankardas MA, Jang IK. Coronary plaque and clinical characteristics of South Asian (Indian) patients with acute coronary syndromes: An optical coherence tomography study. Int J Cardiol. 2021 Nov 15;343:171-179. doi: 10.1016/j.ijcard.2021.08.048. Epub 2021 Sep 3.
citation: Kurihara O, Takano M, Yamamoto E, Yonetsu T, Kakuta T, Soeda T, Yan BP, Crea F, Higuma T, Kimura S, Minami Y, Adriaenssens T, Boeder NF, Nef HM, Kim CJ, Thondapu V, Kim HO, Russo M, Sugiyama T, Fracassi F, Lee H, Mizuno K, Jang IK. Seasonal Variations in the Pathogenesis of Acute Coronary Syndromes. J Am Heart Assoc. 2020 Jul 7;9(13):e015579. doi: 10.1161/JAHA.119.015579. Epub 2020 Jul 2.
citation: Yamamoto E, Yonetsu T, Kakuta T, Soeda T, Saito Y, Yan BP, Kurihara O, Takano M, Niccoli G, Higuma T, Kimura S, Minami Y, Ako J, Adriaenssens T, Boeder NF, Nef HM, Fracassi F, Sugiyama T, Lee H, Crea F, Kimura T, Fujimoto JG, Fuster V, Jang IK. Clinical and Laboratory Predictors for Plaque Erosion in Patients With Acute Coronary Syndromes. J Am Heart Assoc. 2019 Nov 5;8(21):e012322. doi: 10.1161/JAHA.119.012322. Epub 2019 Oct 23.
citation: Sugiyama T, Yamamoto E, Fracassi F, Lee H, Yonetsu T, Kakuta T, Soeda T, Saito Y, Yan BP, Kurihara O, Takano M, Niccoli G, Crea F, Higuma T, Kimura S, Minami Y, Ako J, Adriaenssens T, Boeder NF, Nef HM, Fujimoto JG, Fuster V, Finn AV, Falk E, Jang IK. Calcified Plaques in Patients With Acute Coronary Syndromes. JACC Cardiovasc Interv. 2019 Mar 25;12(6):531-540. doi: 10.1016/j.jcin.2018.12.013.