"I hope you don't get tired of us. We only do what we do," said OutKast's Andre 3000 while thanking the crowd of about 6,000 Thursday at the Tor di Valle hippodrome.
Winners also included Usher, best album for "Confessions" and best male; Alicia Keys, best R&B; Britney Spears , best female; Black Eyed Peas, best pop; and Linkin Park, best rock.
The ceremony featured performances by Usher and Keys, Eminem , Scottish rockers Franz Ferdinand, Swedish punk band The Hives and Gwen Stefani .
Eminem kicked off the show with "Just Lose It," from his new album, "Encore." The Detroit rapper appeared against a backdrop of a camouflaged tank, drummer boys and children dressed as soldiers.
Stefani was lowered onto the stage under a giant red clock in an Alice in Wonderland costume where she danced on top of a table at a set of the Mad Hatter's tea party.
Hip-hop star Nelly was flanked by four dancing girls clad in bejeweled bikinis and feathered headdresses, while The Beastie Boys rode onstage on bicycles and a skateboard.
Rapper Xzibit, the host of the show, was rolled onto the stage on a chariot by aides dressed in black leather gladiator costumes in front of a row of fake Roman columns.
Xzibit said that the event was broadcast to a potential audience of 1 billion people in 156 countries. More than 12 million people cast votes for the awards, he said.
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