The INFUSE - Anterior Myocardial Infarction (AMI) Study

This is a multicenter, open-label, controlled, single-blind, randomized study with up to 452 subjects enrolled in up to 50 US and European sites. Subjects who present with anterior ST-elevation myocardial infarction (STEMI) and an occluded proximal or mid left anterior descending (LAD) with TIMI 0/1/2 flow will be eligible for randomization to one of the following arms:

1. Local infusion of abciximab following thrombus aspiration
2. Local infusion of abciximab and no thrombus aspiration
3. No local infusion and thrombus aspiration
4. No local infusion and no thrombus aspiration

In addition, a cardiac magnetic resonance imaging (MRI) sub-study evaluating microvascular obstruction (MVO) will be performed with up to 160 subjects at up to 20 sites.

The primary objective of the study is to demonstrate that among subjects undergoing primary PCI for anterior STEMI treated with a bivalirudin monotherapy anticoagulation strategy, the intracoronary infusion of an abciximab bolus with or without thrombus aspiration prior to stent implantation, compared to no infusion with or without thrombus aspiration (standard of care), results in 1) reduced infarct size measured by cardiac MRI at 30 days (range -7 days/+14 days; i.e., between 23 and 44 days), 2) reduce microvascular obstruction (MVO) by cardiac MRI at 5 + 2 days (i.e., between 3 and 7 days), 3) enhanced ST-segment resolution, 4) improved myocardial perfusion, 5) reduced thrombus burden and angiographic complications, and 6) no increase in major and minor bleeding.

• Drug: Abciximab local infusion
  Local infusion of abciximab using the ClearWay™ RX Infusion Catheter
• Other: No local infusion
  Intervention without local infusion
• Procedure: Thrombus aspiration
  Thrombus aspiration

• Experimental: Local infusion, thrombus aspiration
  Local infusion of abciximab using the ClearWay™ RX Infusion Catheter following thrombus aspiration.
  Interventions:

  • Drug: Abciximab local infusion
  • Procedure: Thrombus aspiration
• Experimental: Local infusion, no aspiration
  Local infusion of abciximab using the ClearWay™ RX Infusion Catheter and no aspiration
  Intervention: Drug: Abciximab local infusion
• Active Comparator: No local infusion, thrombus aspiration
  No local infusion of abciximab, thrombus aspiration.
  Interventions:

  • Other: No local infusion
  • Procedure: Thrombus aspiration
• Active Comparator: No local infusion, no aspiration
  No local infusion abciximab and no thrombus aspiration
  Intervention: Other: No local infusion

• Stone GW, Maehara A, Witzenbichler B, Godlewski J, Parise H, Dambrink JH, Ochala A, Carlton TW, Cristea E, Wolff SD, Brener SJ, Chowdhary S, El-Omar M, Neunteufl T, Metzger DC, Karwoski T, Dizon JM, Mehran R, Gibson CM; INFUSE-AMI Investigators. Intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction: the INFUSE-AMI randomized trial. JAMA. 2012 May 2;307(17):1817-26. Epub 2012 Mar 25.
• Gibson CM, Maehara A, Lansky AJ, Wohrle J, Stuckey T, Dave R, Cox D, Grines C, Dudek D, Steg G, Parise H, Wolff SD, Cristea E, Stone GW. Rationale and design of the INFUSE-AMI study: A 2 × 2 factorial, randomized, multicenter, single-blind evaluation of intracoronary abciximab infusion and aspiration thrombectomy in patients undergoing percutaneous coronary intervention for anterior ST-segment elevation myocardial infarction. Am Heart J. 2011 Mar;161(3):478-486.e7. Epub 2011 Jan 28.

Key Inclusion Criteria:

• The subject must be >18 years of age;
• Subject is experiencing clinical symptoms consistent with AMI (e.g., chest pain, arm pain, etc.,) >30 minutes duration and unresponsive to nitroglycerin;
• Anterior MI with ECG showing at least 1 mm of ST-segment elevation in 2 or more contiguous leads in V1-V4, or new (or presumably new) left bundle branch block;
• Anticipated symptom onset to balloon or aspiration time of ≤5 hours;
• The subject and his/her physician are willing to comply with specified follow-up evaluations;
• The subject or legally authorized representative has been informed of the nature of the study, agrees to its provisions and has been provided and signed written informed consent, approved by the appropriate Medical Ethics Committee (MEC) or Institutional Review Board (IRB)
• Infarct artery located in the proximal or mid left anterior descending coronary artery, with TIMI 0/1/2 flow at the time of initial diagnostic angiography (prior to wire passage);
• Based on coronary anatomy, PCI is indicated for revascularization;
• Only one epicardial coronary artery will be treated;
• Expected ability to deliver a ClearWay™ RX Infusion Catheter to the infarct lesion (absence of excessive tortuosity, diffuse disease or moderate/heavy calcification).

Key Exclusion Criteria:

• Prior myocardial infarction, or known prior systolic dysfunction (known ejection fraction <40% by any prior measure or regional wall motion abnormalities);
• An elective surgical procedure is planned that would necessitate interruption of anti-platelet agents during the first twelve months post enrollment;
• Subjects who previously underwent coronary stent implantation and in whom coronary angiography demonstrates stent thrombosis to be the cause of the AMI;
• Subject has previously undergone an angioplasty or stenting procedure in the left anterior descending artery;
• Definite planned use of aspiration, atherectomy, thrombectomy and/or distal protection catheters prior to PTCA or stent implantation (other than in subjects randomized to thrombus aspiration);
• Any contraindication to undergo MRI imaging.
• Multivessel intervention required during the index procedure (subjects may be enrolled if treatment of more than one lesion in the LAD or its branches is required, however) (planned staged procedures are permitted with strong recommendation to be performed after 30-day clinical and MRI endpoints are completed);
• Severe vessel tortuosity, diffuse disease or severe calcification is present which may impede successful delivery of the ClearWay™ RX Infusion Catheter or the Export® Aspiration Catheter;
• Features are present highly unfavorable for PCI;
• Target lesion is present within a bypass graft conduit;
• MI is due to thrombosis within or adjacent to a previously implanted stent;
• Left ventriculography demonstrates severe mitral regurgitation or a VSD;
• Unprotected left main stenosis >40% or that will require intervention