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Cangrelor compared with clopidogrel in patients with prior myocardial infarction - Insights from the CHAMPION trials
Alon Eisen1, Robert A Harrington2, Gregg W Stone3
1Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA.
Insights
Patients with prior myocardial infarction (MI) face higher risks after percutaneous coronary intervention (PCI). Cangrelor effectively reduced ischemic events in these patients without increasing severe bleeding risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Patients with a history of myocardial infarction (MI) exhibit elevated risks for adverse events following percutaneous coronary intervention (PCI).
- Understanding the specific impact of prior MI on PCI outcomes is crucial for optimizing patient management.
Purpose of the Study:
- To evaluate the efficacy and safety of cangrelor, an intravenous P2Y12 inhibitor, in patients who have experienced a prior myocardial infarction (MI).
Main Methods:
- Analysis of pooled data from the CHAMPION trials, defining prior MI as a history excluding baseline events.
- Primary endpoint: composite of death, MI, ischemia-driven revascularization, or stent thrombosis within 48 hours.
- Primary safety endpoint: GUSTO-defined severe bleeding within 48 hours.
Main Results:
- Of 24,691 patients, 23% had a prior MI, showing higher primary endpoint rates (4.9% vs. 4.0%, p=0.002).
- Cangrelor demonstrated efficacy in reducing the primary endpoint in both prior MI (4.2% vs. 5.7% clopidogrel) and no prior MI (3.7% vs. 4.3% clopidogrel) groups.
- Severe bleeding rates were similar between cangrelor and clopidogrel in both patient groups (0.1% vs. 0.1% in prior MI; 0.2% vs. 0.2% in no prior MI).
Conclusions:
- Patients with prior MI experienced higher ischemic event rates within 48 hours post-PCI.
- Cangrelor effectively reduced ischemic events in patients with and without prior MI.
- Cangrelor did not significantly increase the risk of severe bleeding in either patient cohort.
Background:
Patients who have had a prior myocardial infarction (MI) are at increased risk for adverse outcomes after subsequent percutaneous coronary intervention (PCI).
Objective:
The objective of this study is to examine the efficacy and safety of cangrelor, a potent intravenous P2Y12 inhibitor, in patients with prior MI.
Methods:
Pooled data from the CHAMPION trials were examined. Prior MI was defined as a history of MI, excluding MI events at baseline. The primary endpoint was a composite of death, MI, ischemia-driven revascularization, or stent thrombosis at 48-h post-randomization. The primary safety endpoint was GUSTO-defined severe bleeding at 48h.
Results:
Out of 24,691 patients, 5699 (23%) had a prior MI. The primary endpoint was higher in patients with vs. without prior MI (4.9% vs. 4.0%, p=0.002). The primary endpoint was 4.2% with cangrelor vs. 5.7% with clopidogrel (absolute risk reduction=1.5%; OR 0.72 [95%CI 0.57-0.92]) in patients with prior MI and 3.7% with cangrelor vs. 4.3% with clopidogrel (absolute risk reduction=0.6%; OR 0.85 [95%CI 0.74-0.99]) in patients without prior MI (P-interaction=0.25). The rate of GUSTO-defined severe bleeding was 0.1% with cangrelor vs. 0.1% with clopidogrel (OR 1.39 [95%CI 0.31-6.24]) in patients with prior MI, and 0.2% with cangrelor vs. 0.2% with clopidogrel (OR 1.18 [95%CI 0.65-2.14]) in patients without prior MI (P-interaction=0.84).
Conclusion:
In the CHAMPION trials, patients with prior MI had higher rates of ischemic outcomes within 48h after PCI. Cangrelor reduced ischemic events with no significant increase in GUSTO-defined severe bleeding in patients with or without prior MI.