A high loading dose of clopidogrel can eliminate the need for abciximab in patients with acute ST-elevation myocardial infarction undergoing angioplasty, according to a late-breaking clinical trial presented at the meeting of the American College of Cardiology.

The BRAVE-3 study was the first to test the influence of high-dose clopidogrel on the value of abciximab exclusively in this patient population.

"Acute myocardial infarction is a major medical problem, and the present study will help to define the optimal treatment strategy," said Julinda Mehilli, MD, 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."

The BRAVE-3 researchers enrolled 800 patients with ST-elevation infarctions who were undergoing angioplasty. All were pretreated with 600 mg clopidogrel and then randomized to intravenous abciximab or placebo during the procedure.

The study was designed primarily to compare how the two treatment strategies affected infarct damage as evaluated by myocardial blood flow on a nuclear scan conducted 5 to 10 days later. There was no difference between groups: Damage involved an average 10 percent of the left ventricle with abciximab and 9 percent with placebo. In addition, the 30-day combined rates of death, repeat infarction, stroke and urgent revascularization procedure 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," Mehilli said.