1. Randomized Comparison in the Setting of Acute MI
CADILLAC Trial Design
Controlled Abciximab and Device Investigation to Lower Late Angioplasty Combinations
Randomized Comparison in the Setting of Acute MI
Balloon angioplasty
(+ abciximab)
Stenting
(+ abciximab) vs
Inclusion Criteria
Lecture Notes
The Controlled Abciximab and Device Investigation to Lower Late Angioplasty Combinations (CADILLAC) trial is a multicenter trial comparison of PTCA  abciximab versus stenting  abciximab in the setting of AMI.
Of 2,625 consecutive patients with AMI, 2,081 patients met the clinical and angiographic eligibility criteria.
Age > 18 years
Nitrate-unresponsive chest pain consistent with acute MI (duration > 30 min but < 12 hours)
Native coronary artery > 2.5 mm, < 4.0 mm
Lesion length < 70 mm

2. CADILLAC Trial Results
Stenting + abciximab (n=525)
PTCA + abciximab2 (n=528 )
PTCA1,3 (n=517 )
Stenting3 (n=511 )
TIMI-3 flow
94%
92%
92%
96.7%
Recurrent ischemia
4.5%
1.5%
3.9%
1.2%
Mortality
1.4%
1.0%
1.6%
1.6%
Lecture Notes
As in the PAMI-STENT trial, the CADILLAC trial demonstrated that primary stenting produced a marked increase in minimal lumen diameter as compared to PTCA (2.7 mm vs 2.15 mm, respectively). (Stone et al, 1999)
Additionally, primary stenting was associated with a lower rate of TIMI grade 3 flow. This lower rate of TIMI grade 3 flow did not translate into early mortality.
The addition of abciximab reversed the effect of stenting on TIMI grade 3 flow, resulting in the highest rate of TIMI grade 3 flow in any of the 4 treatment arms.
The rates of in-hospital mortality, stroke, and reinfarction were similar among the 4 cohorts as was the incidence of bleeding.
Need for ischemic TVR
2.3%
0.2%
0.8%
0.2%
(1) 19.9% provisional stenting; (2) 15.0% provisional stenting; (3) about 5% crossover to abciximab
Stone GR, et al. Presented at the AHA 72nd Scientific Sessions. November, 1999.