1. European Society of Cardiology 2003
GRACIA-2 Trial
Primary Optimal Percutaneous Coronary Intervention versus Facilitated Intervention in STEMI patients
Presented at
European Society of Cardiology 2003

2. GRACIA-2 Trial 212 patients with acute ST elevation MI
Presenting within 12 hours of symptom onset
Enrolled at 15 centers in Spain and Portugal
Optimal Primary PCI
PCI within 3 hours, with or without abciximab
(n = 108)
Facilitated PCI
TNK bolus and enoxaparin immediately
Stent or CABG within 3-12 hours
(n = 104)
Endpoints (follow-up 6 months):
Primary – 1) Infarct size assessed by area under the curve for CKMB and troponin; 2) myocardial reperfusion by ST resolution at 1, 3, and 6 hours; and 3) LV angio at 6 weeks
Secondary – Death, MI, ischemic driven revascularization at 6 weeks and 6 months; Bleeding events
European Society of Cardiology 2003

3. GRACIA-2 Trial: Results
Trial designed to determine if facilitated PCI is as safe and effective as optimal primary PCI alone
Time from randomization to catheterization:
1.08 hours in the primary PCI arm
5.89 hours in the facilitated PCI arm
Infarct size similar in both groups, as was LV ejection fraction evolution at 6 weeks
European Society of Cardiology 2003

4. GRACIA-2 Trial: Epicardial Flow at Initial Angiography
TIMI Grade 3 Flow
p=0.005
TIMI Frame Count
p=0.034
European Society of Cardiology 2003

5. GRACIA-2 Trial: Complete ST Resolution
1 Hour
p=0.19
3 Hours
p=0.83
6 Hours
p=0.03
European Society of Cardiology 2003

6. GRACIA-2 Trial: Clinical Events and Bleeding
Death / MI / Ischemic Driven Revascularization
p=NS
Major Bleed
p=0.97
European Society of Cardiology 2003

7. GRACIA-2 Trial
Angiographic data at initial angiography improved with facilitated PCI
Complete ST resolution at 6 hours improved with facilitated PCI
No increased bleeding with facilitated PCI
No significant difference in clinical outcomes, although sample size small (n=212) and underpwoered to show such a difference