Understanding the risks of non-culprit coronary arteries in heart attack patients

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

This observational study aims to characterize the risk associated with non-culprit coronary arteries in patients who have undergone primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). It will utilize CT coronary angiography to assess the condition of these arteries and investigate the variability in susceptibility to ischemic events among individuals. The study seeks to provide mechanistic insights into how complete revascularization of chronic bystander disease may influence patient outcomes. By analyzing data from patients with multivessel coronary artery disease, the researchers hope to clarify the necessity and benefits of treating non-culprit lesions.

Why it matters

Who can join: the full rules

Inclusion Criteria:

1. Ability to provide written informed consent (post PPCI)
2. Age 18 years to 85 years
3. Presentation of acute STEMI within 12 hours of symptom on-set
4. Culprit artery PPCI
5. Coronary stenosis of \> 50% diameter stenosis by visual estimation in NIRA with a minimum diameter of 2.5mm

Exclusion Criteria:

1. Cardiogenic shock
2. Decompensated heart failure requiring intubation, inotropes, or intra-aortic balloon counter pulsation
3. Refractory ventricular arrhythmia
4. Previous coronary artery bypass surgery (CABG)
5. Stent thrombosis and in stent restenosis
6. An intention before inclusion into the study to revascularize a non-culprit lesion
7. Active malignancy or inflammatory disorders such as rheumatoid arthritis or inflammatory bowel disease
8. Severe valvular heart disease requiring surgery
9. Planned surgical revascularisation
10. Active participation in another study/trial
11. \< 12 months life expectancy
12. Contraindication to CTCA

    * Presence of internal defibrillator
    * Known allergy to iodinated contrast
    * Pregnancy
    * Contraindication to intravenous beta blockade
    * Contraindication to acute sublingual nitrate administration
    * Mechanical prosthetic heart valve
    * Advanced renal impairment (creatinine \>200)
    * Significant valve disease (sever aortic stenosis or regurgitation; severe mitral regurgitation)

Angiographic exclusion criteria

1. NIRA stenosis of 50% or more in the left main stem or the ostia of both the left anterior descending and circumflex arteries
2. \< TIMI (thrombolysis in myocardial infarction) flow grade 3 in the NIRA,
3. Evidence of thrombus in the NIRA.

Where it's running

• University Hospitals Dorset NHS Foundation Trust
  Bournemouth, Dorset, United Kingdom Recruiting
• University Hospital Southampton NHS Foundation Trust
  Southampton, Hampshire, United Kingdom Recruiting
• Royal Stoke University Hospital
  Stoke-on-Trent, Staffordshire, United Kingdom Recruiting

Study contacts

• Principal investigator: Nick Curzen, PhD — University Hospital Southampton NHS Foundation Trust
• Study coordinator: Zoe Nicholas
• Email: zoe.nicholas@uhs.nhs.uk
• Phone: 02381208538

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.