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Effect of Platelet Inhibition by Cangrelor Among Obese Patients Undergoing Coronary Stenting: Insights From CHAMPION
Benjamin E Peterson1, Robert A Harrington2, Gregg W Stone3
1Brigham and Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston (B.E.P., D.L.B.).
Insights
Cangrelor is an effective and safe antiplatelet agent for percutaneous coronary intervention in both obese and nonobese patients. This study found no significant difference in short-term efficacy or safety outcomes based on body mass index (BMI).
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Cangrelor has demonstrated efficacy in reducing ischemic events during percutaneous coronary intervention (PCI) without increasing severe bleeding.
- Previous research suggests that some antiplatelet medications may have varying effects based on a patient's body mass index (BMI).
Purpose of the Study:
- To evaluate the efficacy and safety of cangrelor in percutaneous coronary intervention (PCI) stratified by body mass index (BMI).
- To determine if cangrelor's treatment effect differs between obese (BMI ≥ 30) and nonobese patients undergoing PCI.
Main Methods:
- Analysis of patients from the 3 CHAMPION trials randomized to cangrelor versus clopidogrel during PCI.
- Patients were stratified by BMI (obese vs. nonobese).
- Primary efficacy endpoint: composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis within 48 hours. Safety outcome: GUSTO moderate or severe bleeding at 48 hours.
Main Results:
- No significant difference in the primary efficacy endpoint between obese and nonobese patients (4.3% vs. 4.2%, P=0.82).
- Cangrelor demonstrated consistent efficacy benefits in both obese and nonobese patient groups compared to placebo.
- No difference in GUSTO moderate or severe bleeding was observed between obese and nonobese patients receiving cangrelor versus placebo.
Conclusions:
- Cangrelor is effective and safe for percutaneous coronary intervention (PCI) regardless of patient body mass index (BMI).
- Short-term efficacy outcomes were similar between obese and nonobese patients.
- Periprocedural cangrelor represents a reliable antiplatelet strategy across different BMI categories.
Background:
In randomized trials, cangrelor reduced periprocedural ischemic events related to percutaneous coronary intervention without increasing GUSTO severe bleeding. However, some antiplatelet agents have shown a differential treatment effect by body mass index (BMI).
Methods:
Patients from the 3 CHAMPION trials (Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition) who were randomized to cangrelor versus clopidogrel during percutaneous coronary intervention were stratified by BMI. The primary efficacy end point was a composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis within 48 hours. The principal safety outcome was GUSTO moderate or severe bleeding at 48 hours, although more sensitive bleeding measures such as Thrombolysis in Myocardial Infarction major bleeding were also assessed. We examined obese patients (defined as BMI≥30) versus nonobese patients.
Results:
There were 24 893 patients, with 8979 (36.1%) having BMI of ≥30. There was no significant difference in the primary efficacy end point among obese versus nonobese patients (4.3% versus 4.2%; rate ratio, 1.01 [95% CI, 0.89-1.15]; P=0.82). There was a consistent benefit in the primary efficacy end point in patients who received cangrelor versus placebo who were obese (3.9% versus 4.7%, rate ratio, 0.83 [95% CI, 0.68-1.02]; P=0.07) and not obese (3.8% versus 4.7%; rate ratio, 0.81 [95% CI, 0.69-0.94]; P=0.0053); interaction P=0.77. There was no difference in GUSTO moderate or severe bleeding among patients who received cangrelor versus placebo who were obese (0.6% versus 0.6%; rate ratio, 0.99 [95% CI, 0.58-1.67]; P=0.96).
Conclusions:
Cangrelor at the time of percutaneous coronary intervention is effective and safe in obese and nonobese patients. There was no difference in short-term efficacy between obese and nonobese patients. Periprocedural cangrelor is an effective and safe antiplatelet agent, irrespective of BMI.
Registration:
URL: https://www.
Clinicaltrials:
gov; Unique identifier: NCT01156571, NCT00385138, NCT00305162.
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