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Cangrelor in Older Patients Undergoing Percutaneous Coronary Intervention: Findings From CHAMPION PHOENIX
Matthew A Cavender1, Deepak L Bhatt2, Gregg W Stone1
1From the University of North Carolina, Chapel Hill; (M.A.C.); Brigham and Women's Hospital, Heart and Vascular Center (D.L.B.) and Beth Israel Deaconess Medical Center (C.M.G.), Harvard Medical School, Boston, MA; Columbia University, New York, NY (G.W.S.); Université Paris-Diderot, Sorbonne Paris Cité, INSERM U-1148, DHU FIRE, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, France (G.S.); Institute of Cardiovascular Medicine and Science, National Lung and Heart Institute, Imperial College, Royal Brompton Hospital, London, United Kingdom (G.S.); Kerckhoff Clinic and Thoraxcenter, Bad Nauheim, Germany (C.W.H.); Scripps Clinic, La Jolla, CA (M.J.P.); The Medicines Company, Parsippany, NJ (J.P., S.E., E.N.D.); Stanford University, CA (K.W.M., R.A.H.); and University of Auckland, Auckland City Hospital, New Zealand (H.D.W.).
Insights
Older patients undergoing percutaneous coronary intervention face higher risks. Cangrelor offers similar efficacy to clopidogrel in patients aged 75 and older, without increasing major bleeding events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Older patients undergoing percutaneous coronary intervention (PCI) have a higher risk of periprocedural events.
- The CHAMPION PHOENIX trial evaluated cangrelor versus clopidogrel in 11,145 patients.
- This analysis focuses on the subgroup of patients aged 75 years and older (n=2010).
Purpose of the Study:
- To determine the outcomes of cangrelor versus clopidogrel in patients aged 75 years and older undergoing PCI.
- To assess the efficacy and safety of cangrelor in this specific elderly subgroup.
- To compare bleeding risk and net clinical benefit between the two antiplatelet agents.
Main Methods:
- Analysis of a prespecified subgroup (≥75 years old) from the CHAMPION PHOENIX trial.
- Comparison of primary end points (death, myocardial infarction, ischemia-driven revascularization, stent thrombosis) between cangrelor and clopidogrel.
- Evaluation of Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) moderate/severe bleeding events and a net composite end point.
Main Results:
- Cangrelor showed directionally consistent effects on the primary end point in patients ≥75 years old (OR, 0.71; 95% CI, 0.50-1.02) compared to younger patients.
- Age ≥75 years was an independent predictor of increased GUSTO moderate/severe bleeding (adjusted OR, 2.94; P=0.01).
- No significant difference in GUSTO moderate/severe bleeding was observed between cangrelor and clopidogrel in either age group. The net composite end point favored cangrelor in patients ≥75 years old (OR, 0.75; P=0.09).
Conclusions:
- Patients ≥75 years old have a significantly higher risk of moderate/severe bleeding.
- Cangrelor provides comparable efficacy to clopidogrel in elderly patients undergoing PCI.
- Cangrelor does not increase the risk of major bleeding in patients ≥75 years old compared to clopidogrel.
Background:
Older patients treated with percutaneous coronary intervention are at increased risk of periprocedural events.
Methods And Results:
CHAMPION (cangrelor versus standard therapy to achieve optimal management of platelet inhibition) PHOENIX randomized 11 145 patients to cangrelor or clopidogrel. We sought to determine the outcomes in the prespecified subgroup of patients ≥75 years old (n=2010; 18%). Cangrelor resulted in directionally consistent effects on the primary end point (death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis) in patients ≥75 years old (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.50-1.02) and in those <75 years old (OR, 0.81; 95% CI, 0.67-0.98; P [interaction]=0.55). Age ≥75 years was an independent predictor of GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) moderate/severe bleeding (1.0% versus 0.3%; adjusted OR, 2.94; 95% CI, 1.28-6.77; P=0.01) when compared with patients <75 years old. There was no significant difference in GUSTO moderate/severe bleeding with cangrelor versus clopidogrel (1.1% versus 1.0%; OR, 1.07; 95% CI 0.45-2.53) in patients ≥75 years old or in those <75 years old (0.4% versus 0.2%; OR, 2.24; 95% CI, 1.02-4.93; P [interaction]=0.21). For the net composite end point of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis plus GUSTO moderate/severe bleeding, the OR for cangrelor in those ≥75 years old was 0.75 (6.4% versus 8.3%; 95% CI, 0.54-1.05; P=0.09). The effects were similar in those <75 years old (4.9% versus 5.8%; OR, 0.85; 95% CI, 0.70-1.02; P=0.08; P [interaction]=0.53).
Conclusions:
Patients ≥75 years old have an overall ≈3-fold increased odds of moderate/severe bleeding. Cangrelor, when compared with clopidogrel, provides similar efficacy and in patients ≥75 years old as in those <75 years old but does not increase the risk of major bleeding.
Clinical Trial Registration:
URL: https://www.clinicaltrials.gov. Unique identifier: NCT01156571.
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