The MATRIX Program M. Valgimigli, MD, PhD Erasmus MC Thoraxcenter, Rotterdam The Netherlands NCT

1:1 1:1 NSTEACS or STEMI with invasive management Aspirin+P2Y12 blocker NSTEACS or STEMI with invasive management Aspirin+P2Y12 blocker Trans-Femoral Access Heparin ±GPI Bivalirudin Mono-Tx Stop Infusion Prolong≥ 4 hs infusion 1:1 Trans-Radial Access Is TRI superior to TFI ? Is Bivalirudin superior to UFH ? Should Bivalirudin be prolonged after PCI ? MATRIX Program NCT

1:1 NSTEACS or STEMI with invasive management Aspirin+P2Y12 blocker NSTEACS or STEMI with invasive management Aspirin+P2Y12 blocker Trans-Femoral Access Trans-Radial Access To demonstrate that trans-radial intervention as compared to femoral access site is associated to lower rate of the composite endpoint of Death, MI or Stroke within the first 30 days 1° co-Primary Objective 6% vs. 4.2%, β<10%, α: 2.5%: 8,200 patients Adaptive study Design: sample size (SS) will be increased by the cross-over rate at 70% of planned SS MATRIX Access site NCT

1:1 NSTEACS or STEMI with invasive management Aspirin+P2Y12 blocker NSTEACS or STEMI with invasive management Aspirin+P2Y12 blocker Trans-Femoral Access Trans-Radial Access To demonstrate that trans-radial intervention as compared to femoral access site is associated to lower rate of the composite endpoint of Death, MI, Stroke or BARC V or III bleeds within the first 30 days 2° co-Primary Objective 9% vs. 6.3%, β: 2%, α; 2.5%: 8,200 patients MATRIX Access site NCT Adaptive study Design: sample size (SS) will be increased by the cross-over rate at 70% of planned SS

1:1 NSTEACS or STEMI with invasive management Aspirin+P2Y12 blocker NSTEACS or STEMI with invasive management Aspirin+P2Y12 blocker Heparin ±GPI Bivalirudin Mono-Tx MATRIX Anti-thombin NCT To demonstrate that Bivalirudin as compared to UFH plus provisional GPI is associated to lower rate of the composite endpoint of Death, MI or Stroke within the first 30 days 1° co-Primary Objective 6% vs. 4.2%, β<15%, α: 2.5%: 6,800 patients Adaptive study Design: sample size (SS) will be increased by the cross-over rate at 70% of planned SS

1:1 NSTEACS or STEMI with invasive management Aspirin+P2Y12 blocker NSTEACS or STEMI with invasive management Aspirin+P2Y12 blocker Heparin ±GPI Bivalirudin Mono-Tx MATRIX Anti-thombin NCT To demonstrate that Bivalirudin as compared to UFH plus provisional GPI is associated to lower rate of the composite endpoint of Death, MI, Stroke or or BARC V or III bleeds within the first 30 days 2° co-Primary Objective 9% vs. 6.3%, β<5%, α: 2.5%: 6,800 patients Adaptive study Design: sample size (SS) will be increased by the cross-over rate at 70% of planned SS

NSTEACS or STEMI with invasive management Aspirin+P2Y12 blocker NSTEACS or STEMI with invasive management Aspirin+P2Y12 blocker Bivalirudin Mono-Tx Stop Infusion Prolong≥ 4 hs infusion 1:1 MATRIX Treatment duration NCT To demonstrate that prolonged Bivalirudin infusion is associated to lower rate of the composite endpoint of Death, MI, Stroke, urgent TVR, Stent thrombosis or BARC bleeds V or III within the first 30 days Primary Objective 10% vs. 7%, β<4%, α:5%: 3,400 patients

Recruitment Status August 2014