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Trial registered on ANZCTR
Registration number
ACTRN12616000025437
Ethics application status
Approved
Date submitted
8/01/2016
Date registered
15/01/2016
Date last updated
15/01/2016
Type of registration
Prospectively registered
Titles & IDs
Public title
The Restoring coronary arteries with drug eluting resorbable stents compared to metal stents in patients with diffuse narrowing. The RESTORE feasibility study
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Scientific title
A randomised controlled trial of Rebuilding the lEft anterior deScending artery for LIMA grafTing with biO-ReabsorbablE scaffolds versus conventional management.
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Secondary ID [1]
287045
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Nil known
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Universal Trial Number (UTN)
U1111-1172-7821
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Trial acronym
RESTORE-LAD
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Subjects with diffuse left anterior descending artery disease that is not attractive for surgical revascularization
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Condition category
Condition code
Cardiovascular
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0
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Coronary heart disease
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Participants are randomised 1:1 ratio to reconstruction of the Left Anterior Descending (LAD) with everolimus eluting bioreabsorbable scaffolds or everolimus eluting metal stents.
The ABSORB bioreabsorbable scaffold will be used. Stents are implanted during a percutaneous coronary intervention (PCI) via catheters placed up a major artery from the wrist or groin under local anaesthetic. The implantation procedure is very similar to that of other stents such as the Xience everolimus eluting metallic stents used in the control arm. Procedure duration may vary depending on the complexity of the lesion.
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Intervention code [1]
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Treatment: Devices
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Comparator / control treatment
Everolimus eluting metal stents (Xience) will be used. Stents are implanted during a percutaneous coronary intervention (PCI) via catheters placed up a major artery from the wrist or groin under local anaesthetic. The implantation procedure is very similar to that of other stents such as the ABSORB stents used in the active treatment arm. Procedure duration may vary depending on the complexity of the lesion.
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Control group
Active
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Outcomes
Primary outcome [1]
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Efficacy: Anatomical suitability of the LAD for a LIMA anastomosis as assessed on CT coronary angiography after 2 years.
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Assessment method [1]
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Timepoint [1]
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Two years post procedure
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Primary outcome [2]
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Safety: MACE (all cause death,MI,or Target vessel revascularisation) after 2 years.
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Assessment method [2]
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Timepoint [2]
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Two years post procedure
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Secondary outcome [1]
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First occurence of angina pectoris assessed by Seattle questionaire
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Assessment method [1]
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Timepoint [1]
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One and two years post procedure
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Secondary outcome [2]
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Target vessel MACE by review of hospital records
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Assessment method [2]
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Timepoint [2]
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Two years post procedure
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Secondary outcome [3]
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Left Ventricular function on echocardiography
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Assessment method [3]
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Timepoint [3]
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Two years post procedure
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Secondary outcome [4]
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All MACE as per hospital records and mortality register
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Assessment method [4]
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Timepoint [4]
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Two years post procedure
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Secondary outcome [5]
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All cause death as per hospital records and mortality register
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Assessment method [5]
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Timepoint [5]
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Two years post procedure
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Secondary outcome [6]
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Stent thrombosis as per review of hospital records
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Assessment method [6]
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Timepoint [6]
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Two years post procedure
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Eligibility
Key inclusion criteria
1. Diffuse LAD disease greater than or equal 50mm in length that is not attractive for surgical revascularisation due to LAD anatomy as judged by a cardiothoracic surgeon.
2. Reconstruction of the LAD with BRS is technically feasible as judged by an experienced BRS implanter.
3. Preserved antero-apical wall motion
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Minimum age
18
Years
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Maximum age
70
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Reconstruction of the LAD with BVS is not technically feasible due to deliverability.
2. Significally impaired LV systolic function of the anterior wall without demonstrable ischaemia (FFR <0.80 or moderate to large reversible perfusion defect on ischameia testing in the LAD territory)
3. Unable or unlikely to take or tolerate long term DAPT
4. Intolerance to Everolimus
5. Unlikely to survive the duration of the study due to othe comorbidity
6. Advanced renal disease not on haemodialysis (eGFR <30ml/min)
7. Within 48 hour of STEMI
8. Prior revascularisation of the mid to distal LAD with stents or CABG.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Subjects, referring physicians and study personnel assessing outcomes will be blinded to treatment allocation.
Assessors of the CT-outcomes after 2 years will be blinded to the study name and purpose
Allocation will be via an online randomisation module of REDCAP
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Computer generated random allocation to one of 2 groups in a 1:1 ratio
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 4
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
Descriptive statistics will be used. Proportions will be compared using a Chi-square test. As this is a pilot study no power calculations are relevant
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/02/2016
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Actual
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Date of last participant enrolment
Anticipated
1/07/2017
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
30
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
WA,VIC
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Recruitment hospital [1]
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Royal Perth Hospital - Perth
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Recruitment hospital [2]
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Fiona Stanley Hospital - Murdoch
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Recruitment hospital [3]
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Eastern Heart Clinic - Randwick
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Recruitment postcode(s) [1]
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6000 - Perth
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Recruitment postcode(s) [2]
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6150 - Murdoch
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Recruitment postcode(s) [3]
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3128 - Box Hill
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Recruitment outside Australia
Country [1]
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New Zealand
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State/province [1]
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Christchurch
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Funding & Sponsors
Funding source category [1]
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Commercial sector/Industry
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Name [1]
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Abbott Vascular
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Address [1]
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299 Lane Cove Road
Macquarie Park, NSW 2113
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Country [1]
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Australia
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Primary sponsor type
University
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Name
The University of Western Australia
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Address
35 Stirling Highway
Crawley,
WA
6009
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Country
Australia
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Secondary sponsor category [1]
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Hospital
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Name [1]
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Royal Perth Hospital
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Address [1]
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197 Wellington street
Perth
6000
Western Australia
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Country [1]
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Royal Perth Hospital Ethics Committee
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Ethics committee address [1]
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Kirkman House 197 Wellington Street Perth Western Australia
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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Approval date [1]
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11/09/2015
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Ethics approval number [1]
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Summary
Brief summary
The coronary arteries supply the heart muscle with oxygen rich blood. The Left Anterior Descending artery (LAD) supplies the front part of the heart muscle. Narrowing of the coronary arteries can cause angina and if one of the narrowings block off it can cause a heart attack.. Preventative medication can help to relieve or prevent these problems. When the LAD is narrowed in many places (diffusely diseased) it can often cause angina or breathlessness and medications alone may not be sufficient to treat the diseased artery. In addition to tablets coronary bypass surgery is often the best treatment when there are many narrowings, but for technical reasons it is not a suitable treatment when the LAD is diffusely diseased. It is still possible to reconstruct the artery using long stents during a coronary catheterisation procedure. Reconstruction of the artery with conventional drug eluting metal stents such as Xience can be a very effective treatment, but leaves the vessel in a permanent metal cage with risk of restenosis and stent thrombosis. The standard Xience stent is a metal stent and contains the drug everolimus to prevent the heart artery from re-narrowing. Individual case reports show that diffuse disease in the LAD may be reconstructed using bioreabsorbable scaffolds. The Absorb bioreabsorbable scaffold is made of a special type of plastic consisting of materials called polylactide polymers and copolymers. Over time these materials will gradually break down and be completely resorbed into the artery wall, leaving nothing behind and in principle restoring the natural ability of the artery to change in size in response to the needs of the heart (vasomotion). The Absorb scaffold is also coated with the drug everolimus which helps to prevent the heart artery from re-narrowing. When a narrowing in the arteries is stretched open the scaffolding effect, which prevents the artery from collapsing down again, is needed for only 3-6 months after which the artery grows larger by itself through a process called remodelling. As such the scaffolding effect from metal stent lasts much longer than needed and this can sometimes lead to problems. In theory the reabsorption of the scaffold over time may allow for future bypass grafting of the vessel if needed . While the bioreabsorbable stent seems like a good idea on many levels and initial study results are encouraging, there is much less experience with this new technology Commercial-in-Confidence and in particular whether the long term effects compared to a modern metal stent are better, worse or the same are not known. The aim of the trial is to evaluate whether, in addition to medical therapy, reconstructing the LAD with bioreabsorbable vascular scaffolds may improve outcomes versus treatment with standard Xience stents and specifically whether the artery may become suitable for coronary bypass surgery. The trial is a prospective randomised single blind, blinded end-point assessment; controlled trial
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Prof Carl Schultz
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Address
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Cardiology Department
Royal Perth Hospital Campus, University of Western Australia
197 Wellington Street
Perth
6000
Western Australia
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Country
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Australia
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Phone
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+618 9224-2244
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Fax
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+61 8 9224-2448
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Email
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[email protected]
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Contact person for public queries
Name
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Carl Schultz
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Address
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Royal Perth Hospital
Wellington Street
Perth
6000
Western Australia
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Country
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Australia
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Phone
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+61 8 9224-2244
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Fax
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+61 8 9224-2448
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Email
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[email protected]
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Contact person for scientific queries
Name
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Carl Schultz
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Address
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Royal Perth Hospital
Wellington Street
Perth
6000
Western Australia
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Country
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Australia
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Phone
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+61 8 9224-2244
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Fax
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+61 89224-2448
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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