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J. Mehilli , A. Kastrati, K. Huber, S. Schulz, J. Pache, C.Markwardt, S. Kufner, F. Dotzer, K. Schlotterbeck, J. Dirsc

ClinicalTrials.gov Identifier: NCT00133250. Abciximab in Patients with AMI Undergoing Primary PCI After Clopidogrel Pretreatment. BRAVE-3 Trial B avarian R eperfusion A lternati V es E valuation-3 Trial.

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J. Mehilli , A. Kastrati, K. Huber, S. Schulz, J. Pache, C.Markwardt, S. Kufner, F. Dotzer, K. Schlotterbeck, J. Dirsc

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  1. ClinicalTrials.gov Identifier: NCT00133250 Abciximab in Patients with AMI Undergoing Primary PCI After Clopidogrel Pretreatment BRAVE-3 Trial Bavarian Reperfusion AlternatiVes Evaluation-3 Trial J. Mehilli, A. Kastrati, K. Huber, S. Schulz, J. Pache, C.Markwardt, S. Kufner, F. Dotzer, K. Schlotterbeck, J. Dirschinger, A. Schömig.

  2. Background • Glycoprotein IIb/IIIa inhibitors (GPI) may improve the results of primary PCI in acute STEMI • Pretreatment with a 300mg loading dose of clopidogrel improved the outcome of patients undergoing PCI in the setting of the CLARITY trial • A higher, 600mg loading dose of clopidogrel further enhances and accelerates platelet inhibition

  3. Objective ..to assess whether abciximab further reduces the infarct size in patients with acute ST-elevation myocardial infarction undergoing PCI after pretreatment with 600 mg clopidogrel

  4. Myocardial perfusion % 0% 100% 50% Endpoints Primary endpoint: • SPECT study (5-7days after • randomization) • Final infarct size • (% of the left ventricle) Secondary endpoints: • Death • Myocardial reinfarction • Urgent revascularization • Stroke • Major and minor bleedings (TIMI criteria) • Profound thrombocytopenia

  5. Study Therapy (randomized, double-blind, multicenter) Clopidogrel 600 mg oral Aspirin 500 mg i.v. or oral Unfractionated Heparin 5000 IE Abciximab n=401 Placebo n=399 Aspirin 200mg/day indefinitely Clopidogrel 2 x 75mg/day for 3 days Clopidogrel 75mg/day for at least 4 weeks

  6. Reperfusion Strategy P =.80 100 Drug-eluting stents % Bare metal stents PTCA 60 Medical treatment 20 Abciximab Placebo

  7. Primary Endpoint Final infarct size Mean Final infarct size Median[25th; 75th percentile] 40 P =.76 P = .47 % LV % LV 30 20 10 10 9 0 Abciximab Placebo Abciximab Placebo

  8. 30-Day Mortality P= .53 6 % Abciximab 4 Cumulative Incidence Placebo 2 0 0 5 10 15 20 25 30 Days after randomization

  9. Conclusion In patients with acute STEMI undergoing primary PCI after pre-treatment with a 600mg loading dose of clopidogrel, the additional use of abciximab is notassociated with further reduction in infarct size

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