1. The Pivotal Role of Platelets in Primary PCI Paul Martin PhD Senior Medical Affairs Scientist Centocor/ Eli Lilly UK/Eire/Nordic regions

6. Primary PCI 2003 ESC AMI Guidelines EvidenceLevel of Evidence Recommendations Class IAPreferred treatment if performed by experienced team < 90 min after first medical contact. Class ICIndicated for patients in shock and those with contraindications to fibrinolytic therapy Class I Class IIa AAAA GP IIb/IIIa antagonists and primary PCI no stenting with stenting European Heart Journal 2003;24:28-66.

7. Should the 90 min PCI window be extended?

10. 30 Day Composite Endpoint Summary in 1° PCI Death, MI or Urgent TVR 11.2 10.5 14.6 6.9 10.5 5.8 5.0 6.0 4.5 0 5 10 15 20 % of Patients No Abciximab Abciximab  48% p = 0.03  52% p = 0.04  52% p = 0.01  30% p = 0.02 JACC 2000; 35:915-21. NEJM 2001; 41:1895-03. Circ 1998; 98:734-41. n = 401n = 300n = 2082 n = 483 ISAR-2ADMIRALCADILLAC* RAPPORT  57% p = 0.02 TCT 2002; Oral Pres. n = 400 ACE** * CADILLAC includes ischemic stroke ** ACE includes disabling stroke High Risk PCI adapted from NEJM 2002; 346:957-66 NNT ~20

12. Mortality Outcomes through 1 Year ACE 80 85 90 95 100 0306090120150180210240270300330360 Survival (%) p=.043 95 ± 2 89 ± 2 Stenting plus Abciximab Stenting Alone Time (days) Dr Antonucci, Oral presentation, AHA 2003  5,6 % Absolute Reduction NNT 18

13. Cardiogenic Shock Meta-analysis Clinical Outcomes at 30 Days All cause Mortality p<0.0001 Any BleedingMajor Bleeding p=NS p<0.02 Control (n=226)Abciximab (n=240) % of patients RR 42.4% AR 18.4% Dr Phil Reid, Oral presentation, ESC 2003 NNT: 5

14. “Unless or until there are new data available, we should regard catheter-based reperfusion with adjunctive abciximab therapy as the preferred reperfusion therapy for acute MI.” Topol, Neumann & Montalescot JACC 2003; 42:1886-9

17. Summary Primary PCI with ReoPro remains the gold-standard Facilitated PCI strategy is a work in progress Pre-hospital/ early ReoPro …more data awaited from FINESSE The time-window of Primary PCI may be extended by ReoPro but Phase 3 data needed The platelet is pivotal to Prim. PCI outcomes !