Evaluation of a Modified Anti-Platelet Therapy Associated With Low-dose DES Firehawk in Acute Myocardial Infarction Patients Treated With Complete Revascularization Strategy (TARGET-FIRST)

MicroPort

Status: Active, not recruiting

Conditions: Coronary Artery Disease; Myocardial Infarction, Acute

Treatments: Drug: Standard DAPT; Drug: Shortened DAPT followed by P2Y12 inhibitor monotherapy (cessation of aspirin)

Study type: Interventional

Funder types: NETWORK; Industry

Identifiers

NCT04753749

SFHI01

Details and patient eligibility

About

The study aims to evaluate a modified antiplatelet therapy associated with Firehawk low-dose rapamycin DES in acute myocardial infarction patients treated with complete revascularization strategy. The modified antiplatelet therapy consists of a reduced duration of Dual Antiplatelet Therapy post procedure (ie. 1 month duration) followed by P2Y12 inhibitor monotherapy for the next 11 months. It is hypothesized that in the setting of clinically stable, low to moderate complexity acute Myocardial Infarction patients, a modern approach combining a stent with high biocompatibility feature, complete revascularization strategy and modified antiplatelet therapy may be associated with similar outcomes, or even a significant benefit compared with guidelines-recommended 12-month DAPT. This benefit could be driven by a reduced risk in significant bleeding events, while keeping a comparable protection against ischemic risk. Enrolled subjects will be randomized in a 1:1 ratio to either cessation of aspirin at 1 months, either continuation of DAPT. Selection of the P2Y12 inhibitor agent is left to investigator judgment but has to be in line with the current ESC guidelines. Subjects treated with the Firehawk or Firehawk Liberty coronary stent will be included in this study.

Enrollment: 2,248 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria (General):

• Troponin-positive Non-ST-Elevation MI, requiring early invasive treatment (PCI), or ST-Elevation MI requiring primary PCI, and PCI occurred within the last 7 days
• Subject is eligible for per-protocol antiplatelet treatments
• Written informed consent

Inclusion Criteria (Procedural/angiographic):

• Successful revascularization

• All treated lesions:

  • In native coronary arteries only
  • In vessels with visual reference diameter ≥2.25 mm and ≤ 4.00 mm
  • Implanted with the study device
  • Maximum 3 lesions treated (*)
  • Maximum total stent length ≤ 80 mm

• Complete revascularization performed when more than 1 significant lesion, during the index procedure or in staged procedure(s) occurring within 7 days from the index procedure.

Exclusion Criteria (General):

• Subjects with prior STEMI or prior PCI within 12 months before index admission
• Prior Coronary Artery Bypass Graft (CABG) Surgery
• Cardiogenic shock
• Secondary PCI
• Fibrinolysis
• Prior stent thrombosis
• Planned PCI, CABG, or surgery within 12 months
• Need for Oral Anti-Coagulation therapy
• Ischemic stroke or ICH within 12 months
• eGFR <30 mL/min/1.73 m2 or dialysis
• Active bleeding at time of inclusion or high risk for major bleeding
• History of bleeding diathesis or coagulopathy or subject refuse blood transfusions
• Stage B or C liver cirrhosis or active cancer within 12 months
• Baseline haemoglobin <13 g/dL (12g/dL for women) or anaemia requiring transfusion in the 4 weeks prior to index procedure
• Moderate or severe thrombocytopenia
• Expected non-adherence to protocol or estimated life expectancy ≤12 months
• Known hypersensitivity or contraindication to any medication used in the study or any of the study stent's components/compounds
• Participation in another interventional clinical trial
• Woman who is pregnant, nursing or with known intention to procreate

Exclusion Criteria (Procedural/Angiographic):

• In-stent restenosis or thrombosis
• Chronic total occlusion
• Severe calcification
• True bifurcation disease and side branch diameter ≥ 2mm, or bifurcation treated with 2 stents
• Left main coronary artery lesion
• Residual untreated dissection ≥ C
• Implantation of a non-study stent
• Subject is deemed to receive preferentially CABG within 1 year

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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2,248 participants in 2 patient groups

Shortened DAPT followed by P2Y12 inhibitor monotherapy

Experimental group

Treatment:

Drug: Shortened DAPT followed by P2Y12 inhibitor monotherapy (cessation of aspirin)

Dual Antiplatelet Therapy

Active Comparator group

Treatment:

Drug: Standard DAPT