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| [ ...Back to search results ] | [ Print-friendly version ] |
| The STARS (STeroids Against Re-Stenosis) trial: the use of peri-procedural oral corticosteriods to prevent in-segment re-stenosis after percutaneous coronary intervention |
| Source of record | UK Clinical Trials Gateway |
| ISRCTN | ISRCTN05886349 |
| Date ISRCTN assigned | 02/08/2007 |
| Local reference number(s) | CTA number: 22011/0001/001-0001 |
| Public title | The STARS (STeroids Against Re-Stenosis) trial: the use of peri-procedural oral corticosteriods to prevent in-segment re-stenosis after percutaneous coronary intervention |
| Scientific title | |
| Acronym | The STARS (STeroids Against Re-Stenosis) trial |
| Disease/condition/study domain | Atherosclerosis |
| Study hypothesis | 1. The peri-procedural use of oral corticosteroids in elective/acute patients undergoing percutaneous coronary intervention reduces the incidence of in-segment re-stenosis 2. The use of a chromium cobalt stent results in lower restenosis rates than bare metal stents in elective/acute patients undergoing percutaneous coronary intervention |
| Design/methodology | Double blind 2 x 2 randomised controlled trial |
| Research ethics review | Approval received from the London Multicentre Research Ethics Committee (MREC) on the 5th May 2005 (ref: 04/MREC2/061). |
| Countries of trial | United Kingdom |
| Participants - inclusion criteria | 1. Any patient awaiting percutaneous coronary intervention for symptomatic coronary artery disease (elective or acute) 2. Documented myocardial ischaemia 3. Coronary angiography demonstrating at least a 50% reduction of the luminal diameter in at least one native coronary artery (as measured by quantitative computerised angiography) 4. Any lesion more than 3 mm diameter |
| Participants - exclusion criteria | 1. Proposed use of a drug eluting stent (in the study vessel[s]) 2. Left Main Stem stenosis 3. Primary Percutaneous Coronary Intervention (PCI) for ST elevation myocardial infarction 4. Steroid therapy within 30-days of study enrolment 5. Contraindication to corticosteroid use 6. Previous inclusion in this study 7. Non-cardiac disease likely to cause death within six months 8. Inter-hospital transfers from Cumbria |
| Patient information material | |
| Anticipated start date | 01/01/2006 |
| Anticipated end date | 01/01/2009 |
| Status of trial | Ongoing |
| Target number of participants | 548 |
| Interventions | 1. Prednisolone versus placebo 2. Chromium cobalt stent versus stainless steel stents Steroid randomisation procedure: 1. Acute cases: patients will be randomised via block randomisation 24 hours before their procedure and assigned to the respective study arms by a closed envelope system 2. Elective cases: patients will be randomised via block randomisation at the time of their pre-admission clinic attendance (one-week prior to the procedure) and assigned to the respective study arms by a closed envelope system Stent randomisation procedure: Acute and elective cases: patients will be randomised via block randomisation at the time of their percutaneous coronary intervention procedure if no exclusion criteria are met and assigned to the respective study arms by a closed envelope system. Steroid protocol: Patients will be randomised to oral prednisolone or placebo. Patients will receive prednisolone 40 mg to start 24 hours pre-procedure and to continue for a total of 28-days. Due to dual oral antiplatelet therapy plus oral corticosteroid use, all patients will receive empirical proton pump inhibitor cover (lansoprazole 15 mg/day for 28 days) for the duration of the corticosteroid course (advice taken from a consultant gastroenterologist). Protocol for steroid withdrawal/step-down: Due to the potential risk of adrenal suppression all patients will receive a step-down approach for steroid withdrawal. For the first 14 days patients will receive 40 mg prednisolone. The dose will then be tailed off over the next 14 days as shown below: Day 1 to 14 = 40 mg Day 15 to 19 = 20 mg Day 20 to 24 = 10 mg Day 25 to 28 = 5 mg Registry: Patients' full eligibility for study participation will not be known until the time of coronary angiography as a major inclusion criteria is a lesion of a reference diameter vessel greater than or equal to 3 mm. Lesions less than 3 mm are an exclusion criteria as National Institute for Clinical Excellence (NICE) guidelines advise the use of drug eluting stents in this setting. Therefore some patients will receive study medication up to this point. A registry will be kept of these patients and they will be followed up clinically (via telephone) but not angiographically. |
| Primary outcome measure(s) | Angiographically documented in-segment re-stenosis. |
| Secondary outcome measure(s) | 1. Late loss 2. Target lesion revascularisation: defined as repeat intervention of re-stenotic lesions, which include the target site of the stent implantation or 5 mm proximal and distal in the same epicardial coronary artery 3. Target vessel revascularisation: defined as repeat intervention within the same epicardial coronary artery 4. Target vessel failure: target vessel revascularisation plus any peri-procedural complication related to the procedure 5. Myocardial Infarction (MI) related to the target vessel 6. Incidence of death 7. Unstable angina, congestive cardiac failure 8. Non-fatal MI 9. Q wave MI 9. Non-Q wave MI 10. Cardio-Vascular Accident (CVA) 11. Intracranial haemorrhage 12. Infarction 13. Repeat hospitalisation 14. Major/minor bleeding complications 15. Poor glycaemic control |
| Sources of funding | 1. South Tees Hospitals NHS Trust (UK) - Cardiothoracic Directorate Research and Development Department 2. Guidant Corporation (UK) 3. Cordis Corporation (UK) |
| Sponsor name | South Tees Hospitals NHS Trust (UK) |
| Sponsor details | c/o Dr David R Chadwick Head of Research and Development Marton Road Middlesbrough United Kingdom TS4 3BW |
| Sponsor email | DavidRChadwick@stees.nhs.uk |
| Sponsor website | http://www.southtees.nhs.uk/ |
| Contact name | Dr Andrew Turley |
| Contact details | The James Cook University Hospital Department of Cardiology Cardiothoracic Research Department Red Portacabin Marton Road Middlesbrough United Kingdom TS4 3BW |
| Contact email | a.turley@btopenworld.com |
| More information | For more up-to-date information please go to the ISRCTN link below. |
| Link to record in ISRCTN Register | ISRCTN05886349 |
| Date last extracted from ISRCTN register | 17/04/2008 |
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