Rescue Angioplasty versus Conservative Therapy or Repeat Thrombolysis Trial Presented at American Heart Association Scientific Sessions 2004 Presented by Dr. A. H. Gershlick REACT: 6 month results

www. Clinical trial results.org Repeat Thrombolysis Accelerated tPA or reteplase  n=142 Repeat Thrombolysis Accelerated tPA or reteplase  n=142 Primary Endpoint:  Composite of death, reinfarction, CVA, or severe heart failure at 6 months Primary Endpoint:  Composite of death, reinfarction, CVA, or severe heart failure at 6 months REACT: 6 month results Presented at AHA Acute MI patients with failed thrombolysis aspirin and thrombolytic therapy (60% received streptokinase) within 6 hours of chest pain onset, <50% resolution of ST changes on ECG at 90 minutes 42% anterior infarctions 427 Acute MI patients with failed thrombolysis aspirin and thrombolytic therapy (60% received streptokinase) within 6 hours of chest pain onset, <50% resolution of ST changes on ECG at 90 minutes 42% anterior infarctions Conservative Treatment IV Unfractionated Heparin for 24 hours  n=141 Conservative Treatment IV Unfractionated Heparin for 24 hours  n=141 Rescue PCI Angiography with or without Revascularization  n=144 Rescue PCI Angiography with or without Revascularization  n=144

www. Clinical trial results.org REACT: 6 month results Primary Composite Endpoint at 6 Months (Death, MI, CVA, or severe heart failure) Primary Composite Endpoint at 6 Months (Death, MI, CVA, or severe heart failure) Presented at AHA 2004 The primary composite endpoint of death, MI, CVA or severe heart failure at 6 months was significantly lower in the rescue PCI group compared with either the repeat thrombolysis group or the conservative management group Repeat Thrombolysis Repeat Thrombolysis Rescue PCI Conservative Management Conservative Management p<0.001 p=0.002

www. Clinical trial results.org Presented at AHA 2004 Freedom from revascularization was significantly higher in the rescue PCI group compared with the repeat lysis group or the conservative group (overall p=0.05). Minor bleeding was significantly higher in the rescue PCI group (p<0.001), however, major bleeding did not significantly differ among groups. Freedom from Revascularization Minor Bleeding Events REACT: 6 month results Repeat Thrombolysis Repeat Thrombolysis Rescue PCI Rescue PCI Conservative Management Conservative Management Repeat Thrombolysis Repeat Thrombolysis Rescue PCI Rescue PCI Conservative Management Conservative Management

www. Clinical trial results.org Among patients with acute MI and failed reperfusion after thrombolytic therapy, treatment with rescue angiography was associated with a reduction in the primary composite endpoint of death, reinfarction, CVA, or severe HF at 6 months compared with both repeat thrombolysis or conservative management. These six month results reiterate the trial’s preliminary 30-day results presented at the TCT meeting earlier this year. The secondary positive endpoint of freedom from revascularization was also significantly higher in the rescue angiography group compared with either the thrombolytic or conservative management group However, minor bleeding rates were significantly higher in the rescue PCI group The REACT results support the results of the earlier, smaller RESCUE trial, which showed a trend toward lower death and heart failure with rescue PCI compared with conservative management. On the other hand, these results disagree with those of the recent MERLIN trial, which showed no difference between rescue angiography and conservative treatment strategies at 30 days. Hypotheses offered to explain the opposing outcomes of MERLIN and REACT include differences in initial thrombolysis (↑ streptokinase in MERLIN), concomitant medications (↑ GP IIb/IIIa inhibitors in REACT), and inclusion criteria (↑ time to rescue PCI in MERLIN) Among patients with acute MI and failed reperfusion after thrombolytic therapy, treatment with rescue angiography was associated with a reduction in the primary composite endpoint of death, reinfarction, CVA, or severe HF at 6 months compared with both repeat thrombolysis or conservative management. These six month results reiterate the trial’s preliminary 30-day results presented at the TCT meeting earlier this year. The secondary positive endpoint of freedom from revascularization was also significantly higher in the rescue angiography group compared with either the thrombolytic or conservative management group However, minor bleeding rates were significantly higher in the rescue PCI group The REACT results support the results of the earlier, smaller RESCUE trial, which showed a trend toward lower death and heart failure with rescue PCI compared with conservative management. On the other hand, these results disagree with those of the recent MERLIN trial, which showed no difference between rescue angiography and conservative treatment strategies at 30 days. Hypotheses offered to explain the opposing outcomes of MERLIN and REACT include differences in initial thrombolysis (↑ streptokinase in MERLIN), concomitant medications (↑ GP IIb/IIIa inhibitors in REACT), and inclusion criteria (↑ time to rescue PCI in MERLIN) REACT: Summary