Predicting the Risk of Non-culprit Coronary Artery Disease After a Heart Attack (OCT-RISK)

Guy's and St Thomas' NHS Foundation Trust

Status: Enrolling

Conditions: Ischemic Heart Disease; Coronary Artery Disease; ST Elevation Myocardial Infarction

Treatments: Diagnostic Test: Cardiac magnetic resonance angiogram; Diagnostic Test: Optical coherence tomography and pressure wire assessment

Study type: Observational

Funder types: Other

Identifiers

NCT05781087

FS/CRTF/22/24342 (Other Grant/Funding Number)

292740

Details and patient eligibility

About

Heart attacks caused by the complete blockage of a heart artery are treated by opening it with a stent. However, most people will also have 'non-culprit' narrowings found in their other arteries at this time.

Although in general people do better if these non-culprit narrowings are also treated with stents if they look severe, this process has problems. This is because narrowings that look severe may be stable and not cause any trouble. For these people a stent is a wasted procedure and unnecessary risk. On the other hand, narrowings that are currently left alone because they appear mild, may progress and cause a heart attack.

Participants who have had a heart attack will have a scan from inside the heart arteries during an angiogram (optical coherence tomography, OCT) and a magnetic resonance angiogram (MRA).

If the investigators can show that it is possible to accurately predict which non-culprit narrowings are going to progress and which are going to stabilise, medical professionals may be able to better target their treatments after a heart attack.

Enrollment: 90 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Successful primary percutaneous coronary intervention (PCI) within the previous week with no major complications at the index procedure
• Bystander disease in a non-culprit vessel planned for clinically indicated staged angiography +/- PCI
• Able to provide written informed consent.

Exclusion criteria

• Cardiogenic shock requiring intubation, inotropes or a mechanical support device
• Creatinine clearance <30ml/min
• Prior coronary artery bypass grafting
• Life expectancy less than 3 years
• Pregnancy.
• Target lesion in the left main coronary artery
• Severe calcification or tortuosity that would threaten safe placement of a pressure wire or OCT catheter
• Chronic total occlusion of a major epicardial vessel.

Trial design

90 participants in 1 patient group

Standard of care

Description:

Patients after ST-elevation myocardial infarction with non-culprit coronary artery disease.

Treatment:

Diagnostic Test: Optical coherence tomography and pressure wire assessment

Diagnostic Test: Cardiac magnetic resonance angiogram