March 31, 2008 - Over the years, interventional cardiologists have made many improvements in percutaneous coronary intervention (PCI) for patients with heart attack, among the most important, refinements in the selection and administration of drugs that prevent unwanted blood clotting. Now a new study has found that high loading doses of clopidogrel, an oral medication that inhibits blood clots by preventing platelets from clumping together, can eliminate the need for intravenous abciximab, a standard cath-lab drug that also interferes with platelets, but through a different pathway.
The BRAVE-3 study is the first to test the influence of high-dose clopidogrel on the value of abciximab exclusively in patients with ST-elevation myocardial infarction (STEMI), a serious form of heart attack. The study is being reported today in a Late-Breaking Clinical Trials session at the SCAI Annual Scientific Sessions in Partnership with ACC i2 Summit (SCAI-ACCi2) in Chicago. SCAI-ACCi2 is a scientific meeting for practicing cardiovascular interventionalists sponsored by the Society for Cardiovascular Angiography and Interventions (SCAI) in partnership with the American College of Cardiology (ACC).
“Acute myocardial infarction is a major medical problem, and the present study will help to define the optimal treatment strategy,” said Julinda Mehilli, M.D., an associate professor and staff cardiologist at Deutsches Herzzentrum, Technical University, Munich, Germany. “Therapy without abciximab would certainly be more cost-effective and reduce the risk of bleeding complications.”
For the study Dr. Mehilli and colleagues recruited 800 patients with STEMI who were undergoing PCI. All patients were pretreated with 600 mg of clopidogrel and then randomly assigned to receive intravenous abciximab or a placebo during the procedure.
The study was designed primarily to compare how the two treatment strategies affected the final amount of heart attack damage, as gauged by blood flow in the heart muscle on a nuclear scan five to 10 days later. The researchers found no difference between the two groups: The damage involved 10 percent of the left ventricle, on average, in the abciximab group and 9 percent of the left ventricle in the placebo group. In addition, the 30-day combined rates of death, heart attack, stroke and urgent repeat coronary procedures were similar in the two groups (5 percent and 3.8 percent, respectively).
“For patients with acute ST-elevation myocardial infarction undergoing primary coronary intervention after pre-treatment with a 600-mg loading dose of clopidogrel, the additional use of abciximab is not associated with any measurable benefit after 30 days,” Dr. Mehilli said.
Dr. Mehilli will present the results of the BRAVE-3 study on Sunday, March 30 at 8:30 a.m. CDT in the Grand Ballroom, S100.
For more information: www.acc08.org