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The study will enroll approximately 316 subjects with a wide spectrum of PCI indications (stable angina as well as ACS), who are considered to be at high risk of bleeding. Patients will undergo PCI with implantation of the EluNIR stent, followed by shortened duration (1 months in stable patients, and up to 3 months in ACS patients) of DAPT.
This is a prospective, multi-center (Up to 20 sites), single-arm, open-label post marketing clinical trial.
The objectives: To assess the safety and efficacy of shortened DAPT duration (30 days in stable patients and up to 90 days in ACS patients) following PCI using the EluNIR stent, in patients considered to be at high bleeding risk (HBR).
Patients will be enrolled to the study prior to the PCI procedure.Once a patient has signed an informed consent, met all general and angiographic eligibility criteria, and a guidewire has successfully been passed beyond the target lesion and lesion preparation (if indicated) completed, the patient will be enrolled into the trial.Data collection commences after the subject has signed the informed consent form. Data collection including subject demographic information, laboratory tests, and procedural data as well as follow-up visits or telephone contacts will be captured by the Investigator or site coordinator who has been trained on the CIP and Case Report Forms (CRF).
After discharge from the hospital, each subject will be followed with an in-clinic follow-up visit at 30 days, and follow-up by phone at 6 months and 1year post procedure. Patients with recurrent ischemic events within the first 30 days as well as patients in whom the initial presentation was ACS and in whom the investigator has decided to continue DAPT beyond 30 days will have an additional phone follow-up at 3 months.
The clinical investigation will last for the expected duration of each subject's participation.
Each subject will remain in the clinical investigation for approximately 1 year from the time of the study stent implantation until the last follow-up telephone contact.
The trial population will consist of approximately 316 male and female subjects undergoing PCI for angina (stable or unstable), silent ischemia, non-ST elevation MI (NSTEMI) considered at HBR.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ACS and Non-ACS | DAPT will be stopped at 30 days in non-ACS subjects while at ACS Patients it may be maintained for up to 3 months. In patients with ACS or with an ischemic event during the first 30 days, DAPT may be continued at the discretion of the investigator. In ACS patients DAPT should be continued for a maximum of 3 months. For patients with recurrent ischemic events duration of DAPT therapy will be at the discretion of the investigator. Patients receiving long-term oral anticoagulation with either a Vitamin K inhibitor or a NOAC/DOAC will receive either single antiplatelet therapy with clopidogrel, or DAPT for 30 days (triple therapy) followed by single antiplatelet therapy with clopidogrel. Clopidogrel (75 mg QD) will be given to these patients post procedure for 6 months in stable patients and 12 months in ACS patients. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Percutaneous Coronary Intervention (PCI) | Device | Patients enrolled to the study will undergo angiography followed by PCI according to current guidelines. |
|
| Measure | Description | Time Frame |
|---|---|---|
| The composite of cardiac death, myocardial infarction, or stent thrombosis at 1 year (ARC definite and probable) | 1 Year |
| Measure | Description | Time Frame |
|---|---|---|
| TLF, defined as the composite of cardiac death, target vessel-related MI, or ischemia-driven TLR. | To be evaluated at 30 days, 6 months, and 1 year | |
| Major adverse cardiac events (MACE; the composite rate of cardiac death, any MI or ischemia-driven TLR) |
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Inclusion Criteria:
All inclusion criteria must be present for the patient to be eligible for enrollment.
General Inclusion Criteria
In addition, patients must meet at least one of the following criteria for high risk of bleeding:
Angiographic inclusion criteria (visual estimate)
Exclusion Criteria:
All exclusion criteria must be absent for the patient to be eligible for enrollment.
General Exclusion Criteria
Angiographic Exclusion Criteria (visual estimate)
Note: In case the procedure required the unplanned implantation of a different (non-EluNIR) stent the subject will be de-registered from the study.
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High bleeding risk subjects undergoing PCI using the EluNIR stent for angina, silent ischemia or non STEMI.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Medinol LTD | Tel Aviv | Israel |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38214256 | Derived | Kornowski R, Konigstein M, Jonas M, Assali A, Vaknin-Assa H, Segev A, Danenberg H, Halabi M, Roguin A, Kerner A, Lev E, Karamasis GV, Johnson TW, Anderson R, Blaxill J, Jadhav S, Hoole S, Witberg G, Issever MO, Ben-Yehuda O, Baumbach A. Percutaneous Coronary Interventions Using a Ridaforolimus-Eluting Stent in Patients at High Bleeding Risk. J Am Heart Assoc. 2024 Jan 16;13(2):e029051. doi: 10.1161/JAHA.122.029051. Epub 2024 Jan 12. |
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| ID | Term |
|---|---|
| D023921 | Coronary Stenosis |
| D006470 | Hemorrhage |
| ID | Term |
|---|---|
| D003327 | Coronary Disease |
| D017202 | Myocardial Ischemia |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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| ID | Term |
|---|---|
| D062645 | Percutaneous Coronary Intervention |
| ID | Term |
|---|---|
| D057510 | Endovascular Procedures |
| D014656 | Vascular Surgical Procedures |
| D013504 | Cardiovascular Surgical Procedures |
| D013514 | Surgical Procedures, Operative |
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| To be evaluated at 30 days, 6 months, and 1 year |
| Target vessel failure (TVF; the composite rate of death, target vessel related MI or ischemia-driven TVR) | To be evaluated at 30 days, 6 months, and 1 year |
| The composite of cardiac death, myocardial infarction, or stent thrombosis at 30 days and 6 months | To be evaluated at 30 days, 6 months, and 1 year |
| All-cause mortality | To be evaluated at 30 days, 6 months, and 1 year |
| Cardiac death | To be evaluated at 30 days, 6 months, and 1 year |
| Bleeding events according to BARC definitions | To be evaluated at 30 days, 6 months, and 1 year |
| Myocardial Infarction | To be evaluated at 30 days, 6 months, and 1 year |
| Target Vessel Related MI | To be evaluated at 30 days, 6 months, and 1 year |
| Ischemia-driven TLR | To be evaluated at 30 days, 6 months, and 1 year |
| Ischemia-driven TVR | To be evaluated at 30 days, 6 months, and 1 year |
| Stent Thrombosis (ARC definite and probable) | To be evaluated at 30 days, 6 months, and 1 year |
| Bleeding complications (BARC definitions), evaluated as components and as a composite of BARC Type 3 and 5 bleeding | To be evaluated at 30 days, 6 months, and 1 year |
| D014652 |
| Vascular Diseases |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D019060 | Minimally Invasive Surgical Procedures |