Bavarian Reperfusion Alternatives Evaluation 2:  PCI versus medical therapy in late-presentation MI patients
BRAVE-2 Trial
Presented at
The American College of Cardiology  
Scientific Sessions 2005
Presented by Dr. Adnan Kastrati
Invasive
Angiography, then PCI if necessary
Mean randomization to PCI time: 1.5 hrs
Endpoints:
Primary – Infarct size determined by SPECT at 5-10 days
Secondary – Death, MI, stroke, at 30 days
BRAVE-2 Trial
ACC 2005
Conservative
Conventional medical therapy
365 patients with MI presenting >12 hours after symptom onset
Without ongoing chest pain or Killip class 3/4
BRAVE-2: Primary endpoint
 The primary endpoint of infarct size determined by SPECT at 5-10 days was significantly lower in the invasive arm compared to the conservative arm. 
Infarct Size
(% of left ventricle)

p = 0.002
ACC 2005
BRAVE-2: Secondary Endpoints
ACC 2005
At 30 days, there was no statistically significant difference in clinical end points between the invasive and conservative arms.   
p = 0.21
p = 0.4
p = 0.37
BRAVE - 2: Summary
 Among patients with MI presenting more than 12 hours after symptom onset, invasive treatment was associated with a significant reduction in the primary endpoint of infarct size compared to conservative treatment with medical therapy

 Clinical endpoints of death, MI and stroke were similar between the groups at 30 days

 Further evaluation of the benefit of PCI among late-presenting asymptomatic STEMI patients appears warranted
ACC 2005