Ischemic Events Occur Early in Patients Undergoing Percutaneous Coronary Intervention and Are Reduced With Cangrelor:
Matthew A Cavender1, Robert A Harrington2, Gregg W Stone3
1University of North Carolina, Chapel Hill (M.A.C.).
Insights
Cangrelor significantly reduced early thrombotic events, including myocardial infarction and stent thrombosis, within two hours after percutaneous coronary intervention compared to clopidogrel. These findings highlight the importance of potent platelet inhibition during PCI.
Area of Science:
- Cardiology
- Pharmacology
- Interventional Cardiology
Background:
- Thrombotic events are a significant concern following percutaneous coronary intervention (PCI).
- Cangrelor, an intravenous P2Y12 inhibitor, has demonstrated efficacy in reducing thrombotic events.
- The CHAMPION PHOENIX trial investigated cangrelor versus clopidogrel in patients undergoing PCI.
Purpose of the Study:
- To characterize the timing, number, and type of early thrombotic events occurring within 2 hours of randomization in the CHAMPION PHOENIX trial.
- To evaluate the efficacy of cangrelor in preventing early ischemic events compared to clopidogrel.
Main Methods:
- The CHAMPION PHOENIX trial was a double-blind, placebo-controlled study randomizing patients undergoing PCI to cangrelor or clopidogrel.
- This analysis focused on the first 2 hours post-randomization, assessing the primary endpoint of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis.
- Sensitivity analyses included a secondary endpoint incorporating specific definitions of myocardial infarction and stent thrombosis.
Main Results:
- The majority of events (63%) occurred within 2 hours of randomization, with myocardial infarction being the most common.
- Cangrelor significantly decreased the primary composite endpoint compared to clopidogrel within the first 2 hours (4.1% vs. 5.4%; HR 0.76; P=0.002).
- No significant difference in bleeding events was observed between cangrelor and clopidogrel groups within the first 2 hours.
Conclusions:
- Reductions in ischemic events with cangrelor occurred early, during the active treatment period, supporting its use during PCI.
- These findings underscore the importance of potent platelet inhibition with agents like cangrelor during percutaneous coronary intervention.
- The study provides evidence for the early efficacy of cangrelor in preventing thrombotic complications in PCI patients.
Background:
Thrombotic events are reduced with cangrelor, an intravenous P2Y12 inhibitor. We sought to characterize the timing, number, and type of early events (within 2 hours of randomization) in CHAMPION PHOENIX (A Clinical Trial Comparing Cangrelor to Clopidogrel Standard of Care Therapy in Subjects Who Require Percutaneous Coronary Intervention).
Methods:
CHAMPION PHOENIX was a double-blind, placebo-controlled trial that randomized patients undergoing percutaneous coronary intervention to cangrelor or clopidogrel. For this analysis, we evaluated the efficacy of cangrelor in the first 2 hours postrandomization with regards to the primary end point (death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis). Sensitivity analyses were performed evaluating a secondary, post hoc end point (death, Society of Coronary Angiography and Intervention myocardial infarction, ischemia-driven revascularization, or Academic Research Consortium definite stent thrombosis).
Results:
The majority of events (63%) that occurred in the trial occurred within 2 hours of randomization. The most common early event was myocardial infarction; next were stent thrombosis, ischemia driven revascularization, and death. In the first 2 hours after randomization, cangrelor significantly decreased the primary composite end point compared with clopidogrel (4.1% versus 5.4%; hazard ratio, 0.76 [95% CI, 0.64-0.90], P=0.002). Similar findings were seen for the composite end point of death, Society of Coronary Angiography and Intervention myocardial infarction, ischemia-driven revascularization, or Academic Research Consortium stent thrombosis at 2 hours (0.9% versus 1.6%; hazard ratio, 0.57 [95% CI, 0.40-0.80], P=0.001). Between 2 and 48 hours, there was no difference in the primary composite end point (0.6% versus 0.5%; odds ratio, 1.17 [95% CI, 0.71-1.93]; P=0.53). Early (≤2 hours of randomization) GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) moderate or severe bleeding events were infrequent, and there was no significant difference with cangrelor compared with clopidogrel (0.2% [n=10] versus 0.1% [n=4]; adjusted odds ratio, 1.41 [95% CI, 0.37-5.40]; P=0.62).
Conclusions:
The reductions in ischemic events and overall efficacy seen with cangrelor in CHAMPION PHOENIX occurred early and during the period of time in which patients were being actively treated with cangrelor. These findings provide evidence that supports the importance of potent platelet inhibition during percutaneous coronary intervention. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01156571.
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