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Comparison of the Incidence of Major Cardiovascular Events Between the Combination of Percutaneous Intervention and Optimal Drug Therapy and the Optimal Drug Therapy Alone in Patients With Chronic Coronary Syndrome

NCT07577518 · tracked via the Priya Life Science South Korea tracker
Phase
Not applicable
Started
2026-06-15
Last updated
2026-06-12

Condition(s) studied

Chronic Coronary Syndrome

Investigational drug(s) / intervention(s)

percutaneous coronary interventionGuideline-directed Optimal Medical treatmentCarvedilol Sustained-Release (SR) (Nested RCT subset) →Carvedilol Immediate-Release (IR) (Nested RCT subset) →

percutaneous coronary intervention: PCI will be performed in addition to optimal medical therapy.

Guideline-directed Optimal Medical treatment: Guideline-directed optimal medical therapy alone without PCI

Carvedilol Sustained-Release (SR) (Nested RCT subset): Carvedilol SR (Dilatrend SR; 8/16/32/64 mg) once daily, starting at 32 mg and up-titrated to maximal tolerated dose (up to 128 mg). Applied to Nested RCT participants only (n=220 total across both arms), in whom eligible participants are independently randomized 1:1 to either carvedilol SR or IR - only one formulation is assigned per participant.

Carvedilol Immediate-Release (IR) (Nested RCT subset): Carvedilol IR (Dilatrend; 3.125/6.25/12.5/25 mg) twice daily, starting at 12.5 mg BID and up-titrated to maximal tolerated dose (up to 50 mg BID). Applied to Nested RCT participants only (n=220 total across both arms), in whom eligible participants are independently randomized 1:1 to either carvedilol SR or IR - only one formulation is assigned per participant.

Study summary

Comparison of the incidence of major cardiovascular events between the combination of percutaneous intervention and optimal drug therapy and the optimal drug therapy alone in patients with chronic coronary syndrome.

* Main RCT (Randomized Clinical Trial): Patients with chronic coronary syndrome enrolled in the study will be randomized in a 1:1 ratio to either 1) PCI(Percutaneous Coronary Intervention) plus optimal medical therapy or 2) optimal medical therapy alone, with clinical outcomes assessed during follow-up. (2,301 participants)
* Nested RCT: An embedded randomized supplementary study was conducted on a subset (220 participants) of the total subjects.

In patients who have decided to use beta-blockers for the control of angina, additional 1:1 randomization evaluates the efficacy of carvedilol sustained-release (SR) and immediate-release (IR) formulations. Both formulations are targeted for use up to the maximal tolerated dose, taking into account patient symptoms.

Eligibility

Sex
ALL
Min age
40 Years
Max age
—
Healthy volunteers
No
Inclusion Criteria: * Patients aged 40 years or older * Patients suspected of having chronic coronary syndrome who have undergone coronary angiography and confirmed stenotic lesions * Patients with lesions suitable for stent insertion who have 50% or more visually estimated stenosis in major coronary arteries with a diameter of 2.5 mm or greater observed on coronary angiography, and who satisfy one or more of the following conditions: 1. Patients with stenosis of 70% or more confirmed via Quantitative coronary angiography (50% or more for the left main coronary artery) 2. Minimum lumen area (MLA) ≤ 4 mm² or plaque burden \>70% on intravascular ultrasound (IVUS) 3. MLA \<3.5 mm² or area stenosis (AS) \>65% on Optical Coherence Tomography (OCT) 4. The corresponding stenosis on localizing stress imaging using SPECT or PET When there is a significant focal ischemic deficit in the coronary artery region of the lesion and the total perfusion deficit (TPD) is ≥10% 5. Pressure wire-based fractional flow reserve (FFR) ≤0.80 * Patients who can verbally confirm their understanding of invasive physiological or imaging evaluations and the benefits, harms, and alternative treatments of coronary angioplasty using drug-eluting stents, and for whom the patient or their legal representative can submit a written consent form. Additional Criteria for nested RCT Studies * When heart rate control is deemed therapeutically important due to an accompanying increase in heart rate at rest or during symptomatic episodes. * When the use of beta-blockers is deemed clinically advantageous due to a history of myocardial infarction. * When beta-blockers can help control blood pressure and symptoms in cases of concomitant hypertension. * When there is a clinical situation requiring associated tachyarrhythmia or heart rate control. * When beta-blockers are deemed more appropriate due to a history of contraindications, intolerance, or side effects of calcium channel blockers. Exclusion Criteria: * Patients with Left Ventricular Ejection Fraction (LVEF) less than 35% * Patients with cardiogenic shock * Patients with pulmonary edema or heart failure unresponsive to standard treatment * Patients with unstable angina whose symptoms persist despite maximal drug therapy * Patients with a history of ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), or unstable angina within the last 6 months * Patients with active bleeding * Patients with major bleeding of the gastrointestinal or urinary system within the last 3 months * Patients with coagulation disorders prone to bleeding (including heparin-induced thrombocytopenia) * Patients with hypersensitivity to or contraindications to the following drugs: Heparin, Aspirin, Clopidogrel, Prasugrel, Contrast media (Patients sensitive to contrast media are not excluded if the condition can be effectively prevented through pretreatment with steroids or diphenhydramine (e.g., flare-ups). * Patients for whom percutaneous coronary intervention (PCI) is contraindicated * Patients who have already undergone coronary artery bypass grafting (CABG) * Patients with in-stent restenosis in the target lesion * Patients with chronic total occlusion (CTO) in major coronary arteries * Patients with lesions having an FFR of less than 0.64 * Patients with coronary arteries that are anatomically unsuitable for both PCI and CABG * Patients with non-ischemic dilated cardiomyopathy or hypertrophic cardiomyopathy * Patients with severe valvular disease or those judged by the investigator to be likely to require valve surgery or percutaneous valve replacement during the study period * Patients with non-cardiac diseases, etc., with a life expectancy of less than one year or expected to have low treatment adherence (at the investigator's judgment) * Pregnant or breastfeeding patients * Other patients deemed by the investigator to be unsuitable for participation in the clinical trial Additional Criteria for nested RCT Studies * Significant bradycardia at rest, second-degree or higher atrioventricular block, or significant conduction disturbance * Bronchial asthma or clinically significant bronchospasmodic disease * Symptomatic hypotension * Variant angina as a main presentation * Other cases where the supervising investigator deems the use of beta-blockers medically inappropriate

Primary outcome measure(s)

  • Number of Participants with Patient-oriented composite outcome (POCO), defined as the composite of cardiovascular death, non-fatal myocardial infarction (MI), or clinically driven revascularization — 2nd year and 5th year since registration was complete
    This outcome applies to the main RCT (n=2,301). POCO is a composite of three components: (1) cardiovascular death; (2) non-fatal myocardial infarction, excluding periprocedural MI; and (3) clinically driven revascularization. The first occurrence of any component is counted as the primary event per participant. Clinically driven revascularization is defined as revascularization of a coronary segment with diameter stenosis ≥50% by quantitative coronary angiography, accompanied by at least one of the following: ischemic ECG(Electrocardiogram) changes at rest; typical ischemic symptoms refractory to medical therapy; unstable angina; positive invasive physiologic test (FFR(Fractional Flow Reserve) ≤0.80 or iFR (Instantaneous Wave-Free Ratio) ≤0.89); or angiographic progression with diameter stenosis ≥70% by quantitative coronary angiography regardless of other criteria.
  • Change in Seattle Angina Questionnaire-7 (SAQ-7) Summary Score from Baseline to 12 Months (for Nested RCT) — One year after registration
    This outcome applies to the Nested RCT substudy only (n=220), in which participants eligible for beta-blocker therapy are independently randomized 1:1 to carvedilol SR or IR, regardless of their main trial allocation. The SAQ-7 is a 7-item validated questionnaire assessing angina-related health status across three domains: physical limitation, angina frequency, and quality of life. Scores range from 0 to 100, with higher scores indicating fewer symptoms and better quality of life. The SAQ-7 Summary score is calculated as the mean of the three domain scores.

Trial sites (20)

FacilityCityRegionStatus
Kangwon National University Hospital Chuncheon Gangwon-do
GangNeung Asan Hospital Gangneung Gangwon-do
Hallym University Medical Center Anyang-si Gyeonggi-do
Bucheon Sejong Hospital Bucheon-si Gyeonggi-do
Inje University Ilsan Paik Hospital Goyang-si Gyeonggi-do
Samsung Changwon Medical Center Changwon Gyeongsangnam-do
Inje University Haeundae Paik Hospital Busan South Korea
Pusan National University Hospital Busan South Korea
Kosin University Gospel Hospital Busan South Korea
Keimyung University Dongsan Hospital Daegu South Korea
Kyungpook National University Hospital Daegu South Korea
The Catholic University of Korea Daejeon St. Mary's Hospital Daejeon South Korea
Chungnam National University Hospital Daejeon South Korea
Chungnam National University Hospital Gwangju South Korea
Jeju National University Hospital Jeju City South Korea
Kangdong Sacred Heart Hospital Seoul South Korea
Seoul Metropolitan Government Seoul National University Boramae Medical Center Seoul South Korea
Ewha Womans University Medical Center Seoul South Korea
Koera University Guro Hospital Seoul South Korea
Ulsan Univeristy Hospital Ulsan South Korea
Official registry record

This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.

View NCT07577518 on ClinicalTrials.gov ↗ ← All trials in South Korea