Clinical trial NCT04912518: Cardioprotective Effect of Dexmedetomidine in Patients With ST-segment Elevation Myocardial Infarction
Official title: Cardioprotective Effect of Dexmedetomidine in Patients With ST-segment Elevation Myocardial Infarction: a Double-Blind, Multicenter, Randomized, Placebo-Controlled Clinical Trial
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: ST-segment Elevation Myocardial Infarction (STEMI)
Percutaneous Coronary Intervention
Cardioprotection
Keywords: ST-segment Elevation Myocardial Infarction (STEMI)
Percutaneous coronary intervention
Dexmedetomidine
Cardioprotection
Lead sponsor: Harbin Medical University
Sponsor class: OTHER
Collaborators: name: Yangtze River Pharmaceutical Group Co., Ltd.
First posted: 2021-06-03
Enrollment: 250
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: This is a double-blind, multicenter, randomized, placebo-controlled clinical trial. It is planned to enroll patients admitted with anterior ST-segment elevation myocardial infarction (STEMI) within 6h of symptom onset and undergo primary percutaneous coronary intervention (pPCI). Patients who meet the inclusion criteria and without exclusion criteria were randomized 1:1 into the dexmedetomidine (DEX) group or the placebo (saline) group after signing the informed consent. In the DEX group, intravenous injection of DEX was started immediately after enrollment, covering the entire PCI operation, and the administration was stopped at the end of the pPCI. The administration of saline was the same as those in the DEX group. The primary endpoint was the myocardial infarct size (MIS) as assessed by cardiac magnetic resonance imaging (CMR) at 5±2 days post-STEMI. Based on a superiority design and assuming an 20.0% relative infarct size reduction (from 26.0% to 20.8% with a SD of 13.0%), 250 patients are required to be enrolled, accounting for 20% drop-out (α= 0.05 and power= 80%).


Eligibility criteria: Inclusion Criteria: the enrolled subjects must meet all of the following criteria:

* Aged 18-75 years old (inclusive);
* Diagnosed with anterior STEMI within 6h of symptom onset: (1) ischemic chest discomfort; (2) electrocardiogram (ECG) with ST elevation ≥0.2 mV in 2 or more contiguous precordial leads (one of which should be V2, V3, or V4);
* Sign the informed consent form.

Exclusion Criteria: subjects who meet any one of the following criteria are excluded from the study:

* Ventricular fibrillation, cardiogenic shock, Killip III-IV grade;
* Sinus bradycardia (heart rate sustained \<60 beats/min), PR interval\> 240ms or II-III degree atrioventricular block;
* Continuous systolic blood pressure \<120mmHg;
* Severe breathing difficulties, aterial blood oxygen saturation \<92%;
* Thrombolytic therapy has been performed before the first medical contact in the hospital;
* Consciousness disorder or past cerebrovascular disease;
* Previous history of myocardial infarction or PCI/CABG treatment;
* Known severe liver and kidney dysfunction;
* Known allergy to dexmedetomidine;
* CMR contraindications: such as claustrophobia, pacemaker or ICD implantation;
* Pregnant or lactating women;
* Malignant tumor or expected survival time \<1 year;
* Any condition which in the opinion of the investigator would make it unsafe or unsuitable for the patient to participate in this study (eg, poor compliance, inability of the patient to comply with study procedures and/or follow up);
* Participate in other randomized controlled studies at the same time.

Primary outcomes:
measure: Myocardial infarction size (MIS) evaluated by CMR 5±2 days post-STEMI.
timeFrame: 5±2 days post-STEMI
Secondary outcomes:
measure: Myocardial salvage index (MSI) evaluated by CMR 5±2 days post-STEMI.
timeFrame: 5±2 days post-STEMI
measure: Microvascular obstruction (MVO) evaluated by CMR 5±2 days post-STEMI.
timeFrame: 5±2 days post-STEMI
measure: Left ventricular ejection fraction (LVEF) evaluated by CMR 5±2 days post-STEMI.
timeFrame: 5±2 days post-STEMI
measure: The area under curve (AUC) for troponin I (cTnI) and creatine kinase-MB (CK-MB).
timeFrame: First medical contact in hospital (before drug administration, baseline), and return to ward immediately, 6 Hours, 12 Hours, 24 Hours, 48 Hours after PCI procedure
measure: The peak value for troponin I (cTnI) and creatine kinase-MB (CK-MB).
timeFrame: First medical contact in hospital (before drug administration, baseline), and return to ward immediately, 6 Hours, 12 Hours, 24 Hours, 48 Hours after PCI procedure
measure: LVEF evaluated by echocardiograhy at 30 days post-STEMI.
timeFrame: 30 days post-STEMI
measure: Incidence of major adverse cardiovascular events (MACE): cardiac death, recurrent myocardial infarction, revascularization, rehospitalization due to heart failure.
timeFrame: 30 days and 12 months post-STEMI
Other outcomes:
measure: The major prespecified safety endpoint: a composite of cardiac death during the first 24 hours after admission.
timeFrame: The first 24 hours after admission
measure: The major prespecified safety endpoint: II-III degree atrioventricular block during the first 24 hours after admission.
timeFrame: The first 24 hours after admission
measure: The major prespecified safety endpoint:severe sinus bradycardia during the first 24 hours after admission.
timeFrame: The first 24 hours after admission
measure: The major prespecified safety endpoint:severe hypotension during the first 24 hours after admission.
timeFrame: The first 24 hours after admission
measure: The major prespecified safety endpoint:malignant ventricular arrhythmia during the first 24 hours after admission.
timeFrame: The first 24 hours after admission
Locations:
city: Hefei
country: China
facility: The First Affiliated Hospital of Anhui Medical University
state: Anhui
city: Lanzhou
country: China
facility: The First Affiliated Hospital of Lanzhou University
state: Gansu
city: Harbin
country: China
facility: The Second Affiliated Hospital of Harbin Medical University
state: Heilongjiang
city: Mudanjiang
country: China
facility: Mudanjiang Cardiovascular Hospital
state: Heilongjiang
city: Zhengzhou
country: China
facility: Henan Provincial People's Hospital
state: Henan
city: Wuhan
country: China
facility: Wuhan Asia Heart Hospital
state: Hubei
city: Xi'an
country: China
facility: Shaanxi Provincial People's Hospital
state: Shaanxi
city: Taiyuan
country: China
facility: Shanxi Cardiovascular Hospital
state: Shanxi
city: Tianjin
country: China
facility: Tianjin First Central Hospital
state: Tianjin
Study officials:
affiliation: The Second Affiliated Hospital of Harbin Medical University
name: Bo Yu, M.D., FACC
role: PRINCIPAL_INVESTIGATOR
affiliation: Wuhan Asia Heart Hospital
name: Xi Su
role: PRINCIPAL_INVESTIGATOR
affiliation: Henan Provincial People's Hospital
name: Xiaohui Zheng
role: PRINCIPAL_INVESTIGATOR
affiliation: Mudanjiang cardiovascular hospital
name: Kai Liu
role: PRINCIPAL_INVESTIGATOR
affiliation: Shanxi Cardiovascular Hospital
name: Jian An
role: PRINCIPAL_INVESTIGATOR
affiliation: Shaanxi Provincial People's Hospital
name: Xiling Shou
role: PRINCIPAL_INVESTIGATOR
affiliation: Tianjin First Central Hospital
name: Chengzhi Lu
role: PRINCIPAL_INVESTIGATOR
affiliation: The First Affiliated Hospital of Anhui Medical University
name: Xianhe Lin
role: PRINCIPAL_INVESTIGATOR
affiliation: LanZhou University
name: Zheng Zhang
role: PRINCIPAL_INVESTIGATOR
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