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Ranolazine for Incomplete Vessel Revascularization Post-Percutaneous Coronary Intervention (PCI) (RIVER-PCI)

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by (Responsible Party):
Gilead Sciences
ClinicalTrials.gov Identifier:
NCT01442038
First received: September 22, 2011
Last updated: March 5, 2014
Last verified: March 2014

September 22, 2011
March 5, 2014
October 2011
December 2014   (final data collection date for primary outcome measure)
Time from randomization to first occurrence of ischemia-driven revascularization or ischemia-driven hospitalization without revascularization [ Time Frame: One year ] [ Designated as safety issue: No ]
The primary efficacy endpoint is the incidence of major adverse cardiovascular events (MACE), defined as the composite of cardiovascular (CV) death, or myocardial infarction (MI), or hospitalization for ischemia or angina. [ Time Frame: One year ] [ Designated as safety issue: No ]
Complete list of historical versions of study NCT01442038 on ClinicalTrials.gov Archive Site
  • Time from randomization to sudden cardiac death. [ Time Frame: One year ] [ Designated as safety issue: No ]
  • Time from randomization to cardiovascular death. [ Time Frame: One year ] [ Designated as safety issue: No ]
  • Time from randomization to MI. [ Time Frame: One year ] [ Designated as safety issue: No ]
  • Time from randomization to hospitalization for ischemia or angina. [ Time Frame: One year ] [ Designated as safety issue: No ]
  • Time from randomization to repeat revascularization for ischemia or angina. [ Time Frame: One year ] [ Designated as safety issue: No ]
  • Time from randomization to sudden cardiac death. [ Time Frame: One year ] [ Designated as safety issue: No ]
  • Time from randomization to CV death. [ Time Frame: One year ] [ Designated as safety issue: No ]
  • Time from randomization to MI. [ Time Frame: One year ] [ Designated as safety issue: No ]
Not Provided
Not Provided
 
Ranolazine for Incomplete Vessel Revascularization Post-Percutaneous Coronary Intervention (PCI)
A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study of the Effects of Ranolazine on Major Adverse Cardiovascular Events in Subjects With a History of Chronic Angina Who Undergo Percutaneous Coronary Intervention With Incomplete Revascularization

This study will evaluate the efficacy of ranolazine as compared with placebo when used as part of standard medical therapy in chronic angina subjects with incomplete revascularization post-PCI on the composite of ischemia-driven revascularization or ischemia-driven hospitalization without revascularization.

Not Provided
Interventional
Phase 3
Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator)
Primary Purpose: Treatment
  • Coronary Artery Disease
  • Angina Pectoris
  • Drug: Ranolazine

    Subjects will receive ranolazine 500 milligrams (mg) twice daily for 7 days, followed by 1000 mg administered orally twice daily for the duration of the study.

    Subjects receiving a moderate CYP3A4 inhibitor will receive ranolazine 500 mg or placebo administered orally twice a day for the duration of the concomitant therapy.

    Other Name: Ranexa
  • Drug: Placebo

    Subjects will receive one tablet of matching placebo twice daily for 7 days, followed by two tablets of matching placebo twice daily for the duration of the study.

    Subjects receiving a moderate CYP3A4 inhibitor will receive ranolazine 500 mg or placebo administered orally twice a day for the duration of the concomitant therapy.

  • Experimental: Ranolazine
    Intervention: Drug: Ranolazine
  • Placebo Comparator: Placebo
    Intervention: Drug: Placebo
Weisz G, Farzaneh-Far R, Ben-Yehuda O, Debruyne B, Montalescot G, Lerman A, Mahmud E, Alexander KP, Ohman EM, White HD, Olmsted A, Walker GA, Stone GW. Use of ranolazine in patients with incomplete revascularization after percutaneous coronary intervention: design and rationale of the Ranolazine for Incomplete Vessel Revascularization Post-Percutaneous Coronary Intervention (RIVER-PCI) trial. Am Heart J. 2013 Dec;166(6):953-959.e3. doi: 10.1016/j.ahj.2013.08.004. Epub 2013 Oct 16.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Active, not recruiting
2600
December 2014
December 2014   (final data collection date for primary outcome measure)

Inclusion Criteria:

  1. Written informed consent
  2. Males and females aged 18 years and older
  3. History of chronic angina defined as at least 2 episodes of anginal pain or discomfort in the chest, jaw, shoulder, back, neck, or arm that is precipitated by exertion or emotional stress, and relieved by rest or sublingual nitroglycerin, which occurred on at least 2 separate days and at least 14 days prior to PCI (in the case of staged PCI procedures, at least 14 days prior to the first PCI in the series). Subjects may or may not have additional angina episodes within the 14 days prior to their first PCI in the series, as well as anytime prior to Randomization.
  4. PCI for any indication (ACS or non-ACS). For the purposes of stratification at randomization, ACS will be defined as hospitalization for anginal pain or discomfort within the previous 24 hours to their hospitalization with any one (or more) of the following criteria:

    i. Elevated troponin or creatinine kinase-MB (CK-MB) consistent with MI, as reported by local laboratory and measured prior to index PCI ii. Electrocardiographic changes (including transient changes) comprising new or presumably new ST segment depression ≥ 0.1 mV (≥ 1 mm), or ST segment elevation ≥ 0.1 mV (≥ 1 mm) in at least 2 contiguous leads, or new or presumably new Left Bundle Branch Block

  5. Randomization within 14 days post-PCI. In the case of staged PCI procedures, randomization has to occur within 14 days of the last PCI in the series. Subjects may be randomized starting on the day of PCI and anytime during the following 14 days. PCI is defined as an attempt to cross the lesion with a wire with the intention of performing revascularization.
  6. Post-PCI (post the last PCI for staged procedures) evidence of incomplete revascularization defined as the presence of one or more visually estimated ≥ 50% stenoses in one or more coronary arteries with reference vessel diameter of at least 2.0 mm, whether in the target vessel or in a non-target vessel regardless of the presence or absence of coronary collaterals. In the case of a subject post-CABG, incomplete revascularization is defined as the presence of one or more visually estimated ≥ 50% stenoses in an unbypassed epicardial vessel with a reference diameter of ≥ 2.0 mm, or one or more visually estimated ≥ 50% stenoses in a bypass graft supplying an otherwise unrevascularized myocardial territory.
  7. Clinically stable post-PCI. Subjects randomized in-hospital on day of planned discharge or in clinic are considered stable. Subjects randomized in-hospital prior to day of planned discharge must meet all of the following criteria:

    i. CK-MB < 3 times the upper limit of normal (ULN) at least 3 hours post-PCI, or if ≥ 3 times the ULN with evidence of decreasing CK-MB (decreased by at least 20% from the prior measurement) as reported by local laboratory. If CK-MB is not available, a subject must have evidence of normal or decreasing troponin levels (by at least 20% from the prior measurement) at least 3 hours post-PCI, as reported by local laboratory.

    ii. Systolic blood pressure ≥ 90 mm Hg and not receiving pressors or inotropes iii. No current requirement for an intra-aortic balloon pump (IABP) or any left ventricular assist device iv. No current requirement for intravenous (IV) nitroglycerin

  8. Ability and willingness to comply with all study procedures during the course of the study
  9. Females of childbearing potential must have a negative pregnancy test at Screening (unless surgically sterile or post menopausal) and must agree to use highly effective contraception methods from Screening throughout the duration of study treatment and for 14 days following the last dose of study drug.

Exclusion Criteria:

  1. Any future planned revascularization (including staged procedures) or possible planned revascularization (ie, planned stress test to assess the imminent need for additional revascularization). Future planned stress tests for purposes of monitoring are permitted but strongly discouraged. Subjects may be enrolled after the last PCI in the staged series or once a decision is made not to perform a follow up PCI, as long as Randomization occurs within 14 days from the last PCI. If a subject has had a stress test post-PCI and prior to Randomization and no further intervention is planned, the subject may be enrolled within 14 days from the last PCI.
  2. Unrevascularized left main coronary artery stenosis ≥ 50%. Subjects with a history of CABG to the left coronary system will be considered to have a revascularized left main if at least one graft is patent.
  3. Major complication during or after the index PCI (in the case of staged PCI, the last in the series) including:

    i. Major bleeding (TIMI Bleeding classification or any bleeding requiring blood transfusion of ≥ 2 units of red blood cells) ii. Coronary perforation requiring treatment iii. Procedural complication requiring surgery (including CABG or peripheral vascular surgery)

  4. Stroke within 90 days prior to Randomization, or any history of stroke with permanent major neurologic disability (eg, aphasia or significant motor dysfunction)
  5. Cardiogenic shock within 90 days prior to Randomization (transient decreases in blood pressure without clinical sequelae are not considered to be cardiogenic shock)
  6. New York Heart Association (NYHA) Class III or IV heart failure
  7. Severe renal insufficiency as assessed by an estimated GFR < 30 mL/min/1.73m2 using the 4 variable modification of diet in renal disease (MDRD) equation per local laboratory (based on the last available measurement prior to Randomization, collected within 1 month prior to the index PCI [in the case of staged PCI, the last in the series])
  8. Liver cirrhosis
  9. Use of Class Ia, Ic, or Class III antiarrhythmics, except for amiodarone
  10. Current treatment with strong inhibitors of CYP3A
  11. Current treatment with CYP3A4 inducers or P-gp inducers
  12. Subjects taking > 20 mg simvastatin daily or > 40 mg lovastatin daily who cannot reduce the dose to 20 mg once daily for simvastatin or 40 mg once daily for lovastatin, or who cannot switch to another statin
  13. Subjects taking greater than a total of 1000 mg daily of metformin who cannot reduce the dose to a maximum total of 1000 mg daily (additional anti-diabetic medications may be added as clinically indicated to allow subjects to decrease their metformin dose and maintain glycemic control)
  14. Previous treatment with ranolazine for > 7 consecutive days within 30 days prior to Randomization, or known hypersensitivity or intolerance to ranolazine or to any of the excipients
  15. Participation in another investigational drug or investigational device study within 30 days prior to Randomization (participation in registries is allowed)
  16. Women who are pregnant or breast feeding
  17. Non-CAD comorbid conditions (eg, advanced malignancy, severe aortic stenosis) which are likely to result in death within 2 years of Randomization
  18. Any condition that in the opinion of the investigator would preclude compliance with the study protocol
Both
18 Years and older
No
Contact information is only displayed when the study is recruiting subjects
United States,   Austria,   Belgium,   Canada,   Czech Republic,   France,   Germany,   Israel,   Italy,   Netherlands,   Poland,   Russian Federation,   Spain,   Sweden,   United Kingdom
 
NCT01442038
GS-US-259-0116, 2011-002507-15
Yes
Gilead Sciences
Gilead Sciences
Not Provided
Study Director: Ramin Farzaneh-Far, MD, FACC Gilead Sciences
Gilead Sciences
March 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP