PATCAR: Pre-hospital Administration of Thrombolytic Therapy With Urgent Culprit Artery Revascularization
Study Details
Study Description
Brief Summary
The PATCAR study has been designed to test the hypothesis that the strategy of pre-hospital use of a "clot busting" (thrombolytic) drug followed with emergent heart catheterization including stenting of the problematic coronary artery, will result in a lower mortality and reduced repeat heart attack rates.
Early identifying and treating heart attacks patients prior to the arriving at the hospital, in those patients who qualify for the "clot busting" drugs will lower the size of the heart attack damage. This smaller heart attack will lead to fewer problems with less repeat heart attacks and death in the future.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 4 |
Detailed Description
To demonstrate feasibility of the project in a pilot trial we plan to enroll up to 500 patients to pre-hospital thrombolysis/clot busting followed by emergent catheterization and stenting of the problematic or culprit artery.
This will comprise an EMS system capable of performing pre-hospital ECGs followed by emergent transportation to a Level I Cardiovascular Center where the patients will be taken to urgent cardiac catheterization and emergent stenting of the culprit artery.
Patients identified as having typical symptoms of acute MI and an ECG consistent with acute ST elevation MI will be screened in the field by paramedics or in the spoke hospitals by the ED attending physicians using the screening form. Verbal Consent will be obtained for receiving acute therapy for their MI as outlined in the protocol. After therapy is initiated in the field or at the spoke hospital, the patients will be transported as quickly as possible to the receiving Level I Cardiovascular Center (Hub Hospital). The ED personnel in the Level I Cardiovascular Center will have activated the Interventional Cardiovascular Team and the Cath Lab personnel after having received the initial qualifying transmitted ECG.
Once the patient arrives, informed consent will be obtained by the ED investigator and/or in-house Cardiology fellow for enrollment in the PATCAR Trial. Thrombolytic ineligible patients will also be collect for this study and also go directly to the Cath Lab for PCI. Study coordinators will enter the data into the Case Report Forms and forward the completed forms to Westat-ALA for data capture in the database. In addition to the qualifying ECG, ECG's will be obtained at hospital discharge/transfer. All patients will follow the current standard of care for STEMI/heart attacks patients. Patients will have a Cardiac MRI done on day 3 or 5 of their hospital stay, to measure the size and amount of damage the heart suffered as a result of their Heart attack.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: I Retavase 10 U IV Bolus |
Drug: Retavase 10 U IV Bolus
Retavase IV Bolus, 10 U, one dose at time of myocardial infarction
Other Names:
Procedure: Angioplasty/Heart Catheterization
Candidates will receive all the approved standard therapy for heart attacks patients and will go directly for emergent heart catheterization.
Following local anesthesia, a small flexible tube (catheter) will be inserted in an artery of your leg and advanced to the arteries of your heart. By injecting x-ray contrast through the catheter, any blockage in the artery can be seen. If your heart attack artery is still blocked by blood clot or cholesterol deposits, it will be opened up by angioplasty ("balloon surgery" procedure to open the blocked artery) and stenting (placement of a slotted metal tube in the artery to prevent it from closing on itself).
Device: Drug eluting stent placed in heart attack related artery
Stents will be placed (if needed) during the end of the angioplasty/heart catheterization.
|
| Other: II
|
Procedure: Angioplasty/Heart Catheterization
Candidates will receive all the approved standard therapy for heart attacks patients and will go directly for emergent heart catheterization.
Following local anesthesia, a small flexible tube (catheter) will be inserted in an artery of your leg and advanced to the arteries of your heart. By injecting x-ray contrast through the catheter, any blockage in the artery can be seen. If your heart attack artery is still blocked by blood clot or cholesterol deposits, it will be opened up by angioplasty ("balloon surgery" procedure to open the blocked artery) and stenting (placement of a slotted metal tube in the artery to prevent it from closing on itself).
Device: Drug eluting stent placed in heart attack related artery
Stents will be placed (if needed) during the end of the angioplasty/heart catheterization.
|
Outcome Measures
Primary Outcome Measures
- Mortality and re-infarction rate at six months after trial entry [1 year]
Secondary Outcome Measures
- Safety and bleeding complications (including intracranial bleeding (ICB), need for transfusion, or need for surgery) [1 year]
- Infarction size as measured by cardiac magnetic resonance imaging (MRI) [1 year]
- Reduction in time from onset of pain to reperfusion [1 year]
- Angiographic documentation of reperfusion [1 year]
- Electrocardiogram (ECG) ST segment elevation recovery [1 year]
Eligibility Criteria
Criteria
Inclusion Criteria:
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Ischemic discomfort (squeezing, crushing, or pressure, sub-sternal, unrelated to breathing or movement), epigastric discomfort or pre-syncopal symptoms with diaphoresis, lasting > 30 minutes.
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ST elevation > 0.1 mV in 2 or more contiguous limb leads or > 0.2 mV in 2 or more contiguous pre-cordial leads.
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Less than 6 hours after onset of sustained chest pain.
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Age 18 years or older.
Exclusion Criteria:
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Chest pain described as ripping or tearing, radiating to the back and/or down the leg, and/or systolic blood pressure > 15 mmHg difference in each arm.
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Suspected cocaine or amphetamine use within previous 3 days.
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Known or suspected pregnancy.
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Cardiac arrest requiring intubation.
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Cardiac arrest requiring greater than 20 minutes CPR.
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Coronary intervention (PTCA/stent/CABG) within previous 4 weeks.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Memorial Hermann Hospital / The University of Texas HSC | Houston | Texas | United States | 77030 |
Sponsors and Collaborators
- The University of Texas Health Science Center, Houston
Investigators
- Principal Investigator: Richard W. Smalling, MD, PhD, The University of Texas Health Science Center, Houston
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
None provided.- PATCAR Pilot Trial HSC 03-021