Cangrelor

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Gregg W. Stone - One of the best experts on this subject based on the ideXlab platform.

  • the efficacy and safety of Cangrelor in single vessel vs multivessel percutaneous coronary intervention insights from champion phoenix
    Clinical Cardiology, 2019
    Co-Authors: Gregg W. Stone, Freddy Abnousi, Celina M Yong, Vandana Sundaram, Christoph B Olivier, Jaden Yang, Philippe Gabriel Steg
    Abstract:

    Background The intravenous, rapidly acting P2Y12 inhibitor Cangrelor reduces the rate of ischemic events during PCI with no significant increase in severe bleeding. However, the efficacy and safety of Cangrelor compared with clopidogrel in patients treated with single vessel (SV)-percutaneous coronary intervention (PCI) or multivessel (MV)-PCI remains unexplored. Methods We studied the modified intention-to-treat population of patients from the CHAMPION PHOENIX trial who were randomized to either Cangrelor or clopidogrel. We used logistic regression and propensity score matching to evaluate the effect of Cangrelor compared with clopidogrel on the primary efficacy outcome (composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis) at 48 hours. The safety outcome was moderate or severe Global Utilization of Streptokinase and tPA for Occluded Arteries bleeding at 48 hours. Hypothesis Cangrelor is as efficacious and safe as clopidogrel in both SV and MV PCI. Results Among 10 854 patients, 9204 (85%) underwent SV- and 1650 (15%) MV-PCI. After adjustment, Cangrelor was associated with similar reductions vs clopidogrel in the primary efficacy outcome in patients undergoing SV-PCI (4.5% vs 5.2%; odds ratio [OR] 0.81 [0.66-0.98]) or MV-PCI (6.1% vs 9.8%, OR 0.59 [0.41-0.85]; Pint 0.14). Similar results were observed after propensity score matching (SV-PCI: 5.5% vs 5.9%, OR 0.93 [0.74-1.18]; MV-PCI: 6.2% vs 8.9%, OR 0.67 [0.44-1.01]; Pint 0.17). There was no evidence of heterogeneity in the treatment effect of Cangrelor compared with clopidogrel for the safety outcome. Conclusions In patients undergoing SV- or MV-PCI, Cangrelor was associated with similar relative risk reductions in ischemic complications and no increased risk of significant bleeding compared with clopidogrel, which highlights the expanding repertoire of options for use in complex PCI.

  • impact of lesion complexity on peri procedural adverse events and the benefit of potent intravenous platelet adenosine diphosphate receptor inhibition after percutaneous coronary intervention core laboratory analysis from 10 854 patients from the cha
    European Heart Journal, 2018
    Co-Authors: Gregg W. Stone, Philippe Genereu, Robe A Harringto, Harvey D White, Michael C Gibso, Gabriel P Steg, Christia W Hamm, Kenneth W Mahaffey, Matthew J Price, Jayne Prats
    Abstract:

    Aims In the CHAMPION PHOENIX trial, the potent, rapidly acting, intravenous platelet adenosine diphosphate receptor antagonist Cangrelor reduced the 48-h incidence of major adverse cardiac events (MACE; death, myocardial infarction, stent thrombosis, or ischaemia-driven revascularization) compared with a loading dose of clopidogrel in patients undergoing percutaneous coronary intervention (PCI). We sought to determine whether the efficacy of Cangrelor during PCI varies in patients with simple vs. complex target lesion coronary anatomy. Methods and results Blinded angiographic core laboratory analysis was completed in 10 854 of 10 942 (99.2%) randomized patients in CHAMPION PHOENIX (13 418 target lesions). Outcomes were analysed according to the number of angiographic PCI target lesion high-risk features (HRF) present (bifurcation, left main, thrombus, angulated, tortuous, eccentric, calcified, long, or multi-lesion treatment). The number of patients with 0, 1, 2, and ≥3 HRFs was 1817 (16.7%), 3442 (31.7%), 2901 (26.7%), and 2694 (24.8%), respectively. The 48-h MACE rate in clopidogrel-treated patients increased progressively with lesion complexity (from 3.3% to 4.4% to 6.9% to 8.7%, respectively, P < 0.0001). Cangrelor reduced the 48-h rate of MACE by 21% {4.7% vs. 5.9%, odds ratio (OR) [95% confidence interval (95% CI)] 0.79 (0.67, 0.93), P = 0.006} compared with clopidogrel, an effect which was consistent regardless of PCI lesion complexity (Pinteraction = 0.66) and presentation with stable ischaemic heart disease (SIHD) or an acute coronary syndrome (ACS). By multivariable analysis, the number of high-risk PCI characteristics [OR (95% CI) 1.68 (1.20, 2.36), 2.78 (2.00, 3.87), and 3.23 (2.33, 4.48) for 1, 2, and 3 HRFs compared with 0 HRFs, all P < 0.0001] and treatment with Cangrelor vs. clopidogrel [OR (95% CI) 0.78 (0.66, 0.92), P = 0.004] were independent predictors of the primary 48-h MACE endpoint. Major bleeding rates were unrelated to lesion complexity and were not increased by Cangrelor. Conclusion Peri-procedural MACE after PCI is strongly dependent on the number of treated high-risk target lesion features. Compared with a loading dose of clopidogrel, Cangrelor reduced MACE occurring within 48 h after PCI in patients with SIHD and ACS regardless of baseline lesion complexity. The absolute benefit:risk profile for Cangrelor will therefore be greatest during PCI in patients with complex coronary anatomy. Clinicaltrials.gov identifier NCT01156571.

  • the efficacy and safety of Cangrelor for patients undergoing single vessel versus multi vessel percutaneous coronary intervention insights from the champion phoenix trial
    Journal of the American College of Cardiology, 2018
    Co-Authors: Christoph B Olivier, Gregg W. Stone, Matthew J Price, Michael C Gibson, Ph. Gabriel Steg, Freddy Abnousi, Vandana Sundaram, Jaden Yang, Christian Hamm, Efthymios N Deliargyris
    Abstract:

    The intravenous, rapidly acting P2Y12 inhibitor Cangrelor reduces the rate of ischemic events during percutaneous coronary intervention (PCI) with no significant increase in severe bleeding. This study aimed to evaluate the efficacy and safety of Cangrelor in patients treated with single vessel (SV

  • Cangrelor compared with clopidogrel in patients with prior myocardial infarction - Insights from the CHAMPION trials.
    International journal of cardiology, 2017
    Co-Authors: Alon Eisen, Gregg W. Stone, Matthew J Price, Jayne Prats, Robert A Harrington, Ph. Gabriel Steg, C. Michael Gibson, Christian W. Hamm, Efthymios N Deliargyris, Kenneth W Mahaffey
    Abstract:

    Abstract 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 P2Y 12 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.

  • Cangrelor Versus Clopidogrel on a Background of Unfractionated Heparin (from CHAMPION PHOENIX).
    The American journal of cardiology, 2017
    Co-Authors: Muthiah Vaduganathan, Gregg W. Stone, Matthew J Price, Jayne Prats, Robert A Harrington, Ph. Gabriel Steg, C. Michael Gibson, Christian W. Hamm, Efthymios N Deliargyris, Kenneth W Mahaffey
    Abstract:

    Cangrelor is approved for use during percutaneous coronary intervention (PCI) and is administered with different parenteral anticoagulants. We examined the efficacy and safety of Cangrelor in the subgroup of patients who received unfractionated heparin (UFH) during PCI in the modified intention-to-treat population of the randomized CHAMPION PHOENIX trial (Cangrelor vs clopidogrel; n = 10,939). The primary efficacy end point was the composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis (ST) at 48 hours. The key secondary efficacy end point was ST. UFH was used in 69.2% (7,569/10,939) of patients. In the UFH subgroup, Cangrelor reduced the primary composite efficacy end point at 48 hours compared with clopidogrel (4.8% vs 5.9%; odds ratio [OR] 0.80 [0.65 to 0.98]; p = 0.03). Cangrelor consistently reduced ST at 2 hours (0.7% vs 1.3%; OR 0.56 [0.35 to 0.90]; p = 0.01) and 48 hours (0.9% vs 1.4%; OR 0.70 [0.45 to 1.07]; p = 0.10). There was no difference in GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries)-defined severe or life-threatening bleeding (0.1% vs 0.1%; OR 1.24 [0.33 to 4.61]; p = 0.75) or blood transfusion requirement at 48 hours (0.4% vs 0.2%; OR 1.87 [0.83 to 4.21]; p = 0.12). In conclusion, Cangrelor reduces early ischemic periprocedural complications without increasing severe bleeding compared with clopidogrel in patients undergoing PCI with UFH.

Kenneth W Mahaffey - One of the best experts on this subject based on the ideXlab platform.

  • Cangrelor in clinical use
    Future cardiology, 2020
    Co-Authors: Kent Y. Feng, Kenneth W Mahaffey
    Abstract:

    Inadequate antiplatelet effects can result in substantial morbidity and mortality in patients with acute coronary syndrome and percutaneous coronary intervention (PCI). Cangrelor is a rapid onset and potent intravenous P2Y12 inhibitor that has been shown in large randomized controlled trials to reduce periprocedural complications for PCI compared with clopidogrel, the most commonly used P2Y12 inhibitor. Cangrelor should be considered in the setting of PCI to reduce the risk of periprocedural complications such as myocardial infarction, repeat coronary revascularization and stent thrombosis in patients not yet treated with another P2Y12 inhibitor or glycoprotein IIb/IIIa inhibitor. In this review, the importance of adequate P2Y12 inhibition, Cangrelor's pharmacology and clinical profiles, and future directions for the Cangrelor are discussed.

  • impact of lesion complexity on peri procedural adverse events and the benefit of potent intravenous platelet adenosine diphosphate receptor inhibition after percutaneous coronary intervention core laboratory analysis from 10 854 patients from the cha
    European Heart Journal, 2018
    Co-Authors: Gregg W. Stone, Philippe Genereu, Robe A Harringto, Harvey D White, Michael C Gibso, Gabriel P Steg, Christia W Hamm, Kenneth W Mahaffey, Matthew J Price, Jayne Prats
    Abstract:

    Aims In the CHAMPION PHOENIX trial, the potent, rapidly acting, intravenous platelet adenosine diphosphate receptor antagonist Cangrelor reduced the 48-h incidence of major adverse cardiac events (MACE; death, myocardial infarction, stent thrombosis, or ischaemia-driven revascularization) compared with a loading dose of clopidogrel in patients undergoing percutaneous coronary intervention (PCI). We sought to determine whether the efficacy of Cangrelor during PCI varies in patients with simple vs. complex target lesion coronary anatomy. Methods and results Blinded angiographic core laboratory analysis was completed in 10 854 of 10 942 (99.2%) randomized patients in CHAMPION PHOENIX (13 418 target lesions). Outcomes were analysed according to the number of angiographic PCI target lesion high-risk features (HRF) present (bifurcation, left main, thrombus, angulated, tortuous, eccentric, calcified, long, or multi-lesion treatment). The number of patients with 0, 1, 2, and ≥3 HRFs was 1817 (16.7%), 3442 (31.7%), 2901 (26.7%), and 2694 (24.8%), respectively. The 48-h MACE rate in clopidogrel-treated patients increased progressively with lesion complexity (from 3.3% to 4.4% to 6.9% to 8.7%, respectively, P < 0.0001). Cangrelor reduced the 48-h rate of MACE by 21% {4.7% vs. 5.9%, odds ratio (OR) [95% confidence interval (95% CI)] 0.79 (0.67, 0.93), P = 0.006} compared with clopidogrel, an effect which was consistent regardless of PCI lesion complexity (Pinteraction = 0.66) and presentation with stable ischaemic heart disease (SIHD) or an acute coronary syndrome (ACS). By multivariable analysis, the number of high-risk PCI characteristics [OR (95% CI) 1.68 (1.20, 2.36), 2.78 (2.00, 3.87), and 3.23 (2.33, 4.48) for 1, 2, and 3 HRFs compared with 0 HRFs, all P < 0.0001] and treatment with Cangrelor vs. clopidogrel [OR (95% CI) 0.78 (0.66, 0.92), P = 0.004] were independent predictors of the primary 48-h MACE endpoint. Major bleeding rates were unrelated to lesion complexity and were not increased by Cangrelor. Conclusion Peri-procedural MACE after PCI is strongly dependent on the number of treated high-risk target lesion features. Compared with a loading dose of clopidogrel, Cangrelor reduced MACE occurring within 48 h after PCI in patients with SIHD and ACS regardless of baseline lesion complexity. The absolute benefit:risk profile for Cangrelor will therefore be greatest during PCI in patients with complex coronary anatomy. Clinicaltrials.gov identifier NCT01156571.

  • Cangrelor compared with clopidogrel in patients with prior myocardial infarction - Insights from the CHAMPION trials.
    International journal of cardiology, 2017
    Co-Authors: Alon Eisen, Gregg W. Stone, Matthew J Price, Jayne Prats, Robert A Harrington, Ph. Gabriel Steg, C. Michael Gibson, Christian W. Hamm, Efthymios N Deliargyris, Kenneth W Mahaffey
    Abstract:

    Abstract 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 P2Y 12 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.

  • Cangrelor Versus Clopidogrel on a Background of Unfractionated Heparin (from CHAMPION PHOENIX).
    The American journal of cardiology, 2017
    Co-Authors: Muthiah Vaduganathan, Gregg W. Stone, Matthew J Price, Jayne Prats, Robert A Harrington, Ph. Gabriel Steg, C. Michael Gibson, Christian W. Hamm, Efthymios N Deliargyris, Kenneth W Mahaffey
    Abstract:

    Cangrelor is approved for use during percutaneous coronary intervention (PCI) and is administered with different parenteral anticoagulants. We examined the efficacy and safety of Cangrelor in the subgroup of patients who received unfractionated heparin (UFH) during PCI in the modified intention-to-treat population of the randomized CHAMPION PHOENIX trial (Cangrelor vs clopidogrel; n = 10,939). The primary efficacy end point was the composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis (ST) at 48 hours. The key secondary efficacy end point was ST. UFH was used in 69.2% (7,569/10,939) of patients. In the UFH subgroup, Cangrelor reduced the primary composite efficacy end point at 48 hours compared with clopidogrel (4.8% vs 5.9%; odds ratio [OR] 0.80 [0.65 to 0.98]; p = 0.03). Cangrelor consistently reduced ST at 2 hours (0.7% vs 1.3%; OR 0.56 [0.35 to 0.90]; p = 0.01) and 48 hours (0.9% vs 1.4%; OR 0.70 [0.45 to 1.07]; p = 0.10). There was no difference in GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries)-defined severe or life-threatening bleeding (0.1% vs 0.1%; OR 1.24 [0.33 to 4.61]; p = 0.75) or blood transfusion requirement at 48 hours (0.4% vs 0.2%; OR 1.87 [0.83 to 4.21]; p = 0.12). In conclusion, Cangrelor reduces early ischemic periprocedural complications without increasing severe bleeding compared with clopidogrel in patients undergoing PCI with UFH.

  • Cangrelor versus clopidogrel on a background of unfractionated heparin insights from champion phoenix
    Journal of the American College of Cardiology, 2017
    Co-Authors: Muthiah Vaduganathan, Gregg W. Stone, Jayne Prats, Michael C Gibson, Robert A Harrington, Christian W. Hamm, Efthymios N Deliargyris, Philippe Gabriel Steg, Matthew Price, Kenneth W Mahaffey
    Abstract:

    Background: Cangrelor is approved for use during percutaneous coronary intervention (PCI) and is administered with different intravenous anticoagulants. Methods: We examined the efficacy and safety of Cangrelor in the subgroup of patients who received unfractionated heparin for PCI in the mITT

Matthew J Price - One of the best experts on this subject based on the ideXlab platform.

  • impact of lesion complexity on peri procedural adverse events and the benefit of potent intravenous platelet adenosine diphosphate receptor inhibition after percutaneous coronary intervention core laboratory analysis from 10 854 patients from the cha
    European Heart Journal, 2018
    Co-Authors: Gregg W. Stone, Philippe Genereu, Robe A Harringto, Harvey D White, Michael C Gibso, Gabriel P Steg, Christia W Hamm, Kenneth W Mahaffey, Matthew J Price, Jayne Prats
    Abstract:

    Aims In the CHAMPION PHOENIX trial, the potent, rapidly acting, intravenous platelet adenosine diphosphate receptor antagonist Cangrelor reduced the 48-h incidence of major adverse cardiac events (MACE; death, myocardial infarction, stent thrombosis, or ischaemia-driven revascularization) compared with a loading dose of clopidogrel in patients undergoing percutaneous coronary intervention (PCI). We sought to determine whether the efficacy of Cangrelor during PCI varies in patients with simple vs. complex target lesion coronary anatomy. Methods and results Blinded angiographic core laboratory analysis was completed in 10 854 of 10 942 (99.2%) randomized patients in CHAMPION PHOENIX (13 418 target lesions). Outcomes were analysed according to the number of angiographic PCI target lesion high-risk features (HRF) present (bifurcation, left main, thrombus, angulated, tortuous, eccentric, calcified, long, or multi-lesion treatment). The number of patients with 0, 1, 2, and ≥3 HRFs was 1817 (16.7%), 3442 (31.7%), 2901 (26.7%), and 2694 (24.8%), respectively. The 48-h MACE rate in clopidogrel-treated patients increased progressively with lesion complexity (from 3.3% to 4.4% to 6.9% to 8.7%, respectively, P < 0.0001). Cangrelor reduced the 48-h rate of MACE by 21% {4.7% vs. 5.9%, odds ratio (OR) [95% confidence interval (95% CI)] 0.79 (0.67, 0.93), P = 0.006} compared with clopidogrel, an effect which was consistent regardless of PCI lesion complexity (Pinteraction = 0.66) and presentation with stable ischaemic heart disease (SIHD) or an acute coronary syndrome (ACS). By multivariable analysis, the number of high-risk PCI characteristics [OR (95% CI) 1.68 (1.20, 2.36), 2.78 (2.00, 3.87), and 3.23 (2.33, 4.48) for 1, 2, and 3 HRFs compared with 0 HRFs, all P < 0.0001] and treatment with Cangrelor vs. clopidogrel [OR (95% CI) 0.78 (0.66, 0.92), P = 0.004] were independent predictors of the primary 48-h MACE endpoint. Major bleeding rates were unrelated to lesion complexity and were not increased by Cangrelor. Conclusion Peri-procedural MACE after PCI is strongly dependent on the number of treated high-risk target lesion features. Compared with a loading dose of clopidogrel, Cangrelor reduced MACE occurring within 48 h after PCI in patients with SIHD and ACS regardless of baseline lesion complexity. The absolute benefit:risk profile for Cangrelor will therefore be greatest during PCI in patients with complex coronary anatomy. Clinicaltrials.gov identifier NCT01156571.

  • the efficacy and safety of Cangrelor for patients undergoing single vessel versus multi vessel percutaneous coronary intervention insights from the champion phoenix trial
    Journal of the American College of Cardiology, 2018
    Co-Authors: Christoph B Olivier, Gregg W. Stone, Matthew J Price, Michael C Gibson, Ph. Gabriel Steg, Freddy Abnousi, Vandana Sundaram, Jaden Yang, Christian Hamm, Efthymios N Deliargyris
    Abstract:

    The intravenous, rapidly acting P2Y12 inhibitor Cangrelor reduces the rate of ischemic events during percutaneous coronary intervention (PCI) with no significant increase in severe bleeding. This study aimed to evaluate the efficacy and safety of Cangrelor in patients treated with single vessel (SV

  • Cangrelor compared with clopidogrel in patients with prior myocardial infarction - Insights from the CHAMPION trials.
    International journal of cardiology, 2017
    Co-Authors: Alon Eisen, Gregg W. Stone, Matthew J Price, Jayne Prats, Robert A Harrington, Ph. Gabriel Steg, C. Michael Gibson, Christian W. Hamm, Efthymios N Deliargyris, Kenneth W Mahaffey
    Abstract:

    Abstract 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 P2Y 12 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.

  • Cangrelor Versus Clopidogrel on a Background of Unfractionated Heparin (from CHAMPION PHOENIX).
    The American journal of cardiology, 2017
    Co-Authors: Muthiah Vaduganathan, Gregg W. Stone, Matthew J Price, Jayne Prats, Robert A Harrington, Ph. Gabriel Steg, C. Michael Gibson, Christian W. Hamm, Efthymios N Deliargyris, Kenneth W Mahaffey
    Abstract:

    Cangrelor is approved for use during percutaneous coronary intervention (PCI) and is administered with different parenteral anticoagulants. We examined the efficacy and safety of Cangrelor in the subgroup of patients who received unfractionated heparin (UFH) during PCI in the modified intention-to-treat population of the randomized CHAMPION PHOENIX trial (Cangrelor vs clopidogrel; n = 10,939). The primary efficacy end point was the composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis (ST) at 48 hours. The key secondary efficacy end point was ST. UFH was used in 69.2% (7,569/10,939) of patients. In the UFH subgroup, Cangrelor reduced the primary composite efficacy end point at 48 hours compared with clopidogrel (4.8% vs 5.9%; odds ratio [OR] 0.80 [0.65 to 0.98]; p = 0.03). Cangrelor consistently reduced ST at 2 hours (0.7% vs 1.3%; OR 0.56 [0.35 to 0.90]; p = 0.01) and 48 hours (0.9% vs 1.4%; OR 0.70 [0.45 to 1.07]; p = 0.10). There was no difference in GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries)-defined severe or life-threatening bleeding (0.1% vs 0.1%; OR 1.24 [0.33 to 4.61]; p = 0.75) or blood transfusion requirement at 48 hours (0.4% vs 0.2%; OR 1.87 [0.83 to 4.21]; p = 0.12). In conclusion, Cangrelor reduces early ischemic periprocedural complications without increasing severe bleeding compared with clopidogrel in patients undergoing PCI with UFH.

  • evaluation of ischemic and bleeding risks associated with 2 parenteral antiplatelet strategies comparing Cangrelor with glycoprotein iib iiia inhibitors an exploratory analysis from the champion trials
    JAMA Cardiology, 2017
    Co-Authors: Muthiah Vaduganathan, Gregg W. Stone, Matthew J Price, Michael C Gibson, Robert A Harrington, Ph. Gabriel Steg, Christian W. Hamm, Efthymios N Deliargyris, Alberto Menozzi, Jayne Prats
    Abstract:

    Importance In the context of contemporary pharmacotherapy, optimal antiplatelet management with percutaneous coronary intervention (PCI) has not been well established. Objective To compare the ischemic and bleeding risks associated with glycoprotein IIb/IIIa inhibitors (GPIs) and a potent P2Y 12 antagonist, Cangrelor, in patients undergoing PCI. Design, Setting, and Participants An exploratory analysis of pooled patient-level data from the 3 phase 3 Cangrelor vs Standard Therapy to Achieve Optimal Management of Platelet Inhibition (CHAMPION PCI, CHAMPION PLATFORM, and CHAMPION PHOENIX) trials of patients undergoing elective or nonelective PCI. The participants included 10 929 patients assigned to Cangrelor but not receiving GPIs (Cangrelor alone) and 1211 patients assigned to clopidogrel (or placebo) and receiving routine GPIs (clopidogrel-GPI). Patients requiring bailout or rescue GPI therapy were excluded. To account for risk imbalances, 1:1 propensity score matching based on 16 baseline clinical variables yielded 1021 unique matched pairs. The present study’s data analysis was conducted from October 28, 2015, to August 6, 2016. Main Outcomes and Measures The primary efficacy end point was the composite of all-cause mortality, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours. Safety was assessed by 3 validated bleeding scales (Global Use of Strategies to Open Occluded Coronary Arteries [GUSTO], Thrombolysis in Myocardial Infarction [TIMI], and Acute Catheterization and Urgent Intervention Triage) and requirement for blood transfusions. Results Of the 12 140 patients included in the analysis, 8779 were men (72.3%), and the mean (SD) age was 63.2 (11.3) years. Patients in the clopidogrel-GPI group were more likely to be male (75.6% vs 71.9%), younger (median, 60 [range, 23-91] years vs 64 [range, 26-95] years), enrolled from the United States (77.9% vs 40.0%), and present with an acute coronary syndrome, but they had lower comorbid disease burden and were less likely to receive bivalirudin (8.8% vs 27.3%). In the matched cohorts, the rates of the primary efficacy end point were not significantly different between the Cangrelor alone and clopidogrel-GPI groups (2.6% vs 3.3%; odds ratio [OR], 0.79; 95% CI, 0.48-1.32). There was a nonsignificant trend toward lower rates of GUSTO-defined severe/life-threatening bleeding with Cangrelor alone compared with clopidogrel-GPI (0.3% vs 0.7%; OR, 0.43; 95% CI, 0.11-1.66). Rates of TIMI-defined major or minor bleeding were significantly lower in patients treated with Cangrelor alone (0.7% vs 2.4%; OR, 0.29; 95% CI, 0.13-0.68). Conclusions and Relevance Based on a pooled analysis from the 3 phase 3 CHAMPION trials, Cangrelor alone was associated with similar ischemic risk and lower risk-adjusted bleeding risk compared with clopidogrel-GPIs. Trial Registration clinicaltrials.gov Identifiers:NCT00305162,NCT00385138, andNCT01156571

Jayne Prats - One of the best experts on this subject based on the ideXlab platform.

  • impact of lesion complexity on peri procedural adverse events and the benefit of potent intravenous platelet adenosine diphosphate receptor inhibition after percutaneous coronary intervention core laboratory analysis from 10 854 patients from the cha
    European Heart Journal, 2018
    Co-Authors: Gregg W. Stone, Philippe Genereu, Robe A Harringto, Harvey D White, Michael C Gibso, Gabriel P Steg, Christia W Hamm, Kenneth W Mahaffey, Matthew J Price, Jayne Prats
    Abstract:

    Aims In the CHAMPION PHOENIX trial, the potent, rapidly acting, intravenous platelet adenosine diphosphate receptor antagonist Cangrelor reduced the 48-h incidence of major adverse cardiac events (MACE; death, myocardial infarction, stent thrombosis, or ischaemia-driven revascularization) compared with a loading dose of clopidogrel in patients undergoing percutaneous coronary intervention (PCI). We sought to determine whether the efficacy of Cangrelor during PCI varies in patients with simple vs. complex target lesion coronary anatomy. Methods and results Blinded angiographic core laboratory analysis was completed in 10 854 of 10 942 (99.2%) randomized patients in CHAMPION PHOENIX (13 418 target lesions). Outcomes were analysed according to the number of angiographic PCI target lesion high-risk features (HRF) present (bifurcation, left main, thrombus, angulated, tortuous, eccentric, calcified, long, or multi-lesion treatment). The number of patients with 0, 1, 2, and ≥3 HRFs was 1817 (16.7%), 3442 (31.7%), 2901 (26.7%), and 2694 (24.8%), respectively. The 48-h MACE rate in clopidogrel-treated patients increased progressively with lesion complexity (from 3.3% to 4.4% to 6.9% to 8.7%, respectively, P < 0.0001). Cangrelor reduced the 48-h rate of MACE by 21% {4.7% vs. 5.9%, odds ratio (OR) [95% confidence interval (95% CI)] 0.79 (0.67, 0.93), P = 0.006} compared with clopidogrel, an effect which was consistent regardless of PCI lesion complexity (Pinteraction = 0.66) and presentation with stable ischaemic heart disease (SIHD) or an acute coronary syndrome (ACS). By multivariable analysis, the number of high-risk PCI characteristics [OR (95% CI) 1.68 (1.20, 2.36), 2.78 (2.00, 3.87), and 3.23 (2.33, 4.48) for 1, 2, and 3 HRFs compared with 0 HRFs, all P < 0.0001] and treatment with Cangrelor vs. clopidogrel [OR (95% CI) 0.78 (0.66, 0.92), P = 0.004] were independent predictors of the primary 48-h MACE endpoint. Major bleeding rates were unrelated to lesion complexity and were not increased by Cangrelor. Conclusion Peri-procedural MACE after PCI is strongly dependent on the number of treated high-risk target lesion features. Compared with a loading dose of clopidogrel, Cangrelor reduced MACE occurring within 48 h after PCI in patients with SIHD and ACS regardless of baseline lesion complexity. The absolute benefit:risk profile for Cangrelor will therefore be greatest during PCI in patients with complex coronary anatomy. Clinicaltrials.gov identifier NCT01156571.

  • Cangrelor compared with clopidogrel in patients with prior myocardial infarction - Insights from the CHAMPION trials.
    International journal of cardiology, 2017
    Co-Authors: Alon Eisen, Gregg W. Stone, Matthew J Price, Jayne Prats, Robert A Harrington, Ph. Gabriel Steg, C. Michael Gibson, Christian W. Hamm, Efthymios N Deliargyris, Kenneth W Mahaffey
    Abstract:

    Abstract 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 P2Y 12 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.

  • Cangrelor Versus Clopidogrel on a Background of Unfractionated Heparin (from CHAMPION PHOENIX).
    The American journal of cardiology, 2017
    Co-Authors: Muthiah Vaduganathan, Gregg W. Stone, Matthew J Price, Jayne Prats, Robert A Harrington, Ph. Gabriel Steg, C. Michael Gibson, Christian W. Hamm, Efthymios N Deliargyris, Kenneth W Mahaffey
    Abstract:

    Cangrelor is approved for use during percutaneous coronary intervention (PCI) and is administered with different parenteral anticoagulants. We examined the efficacy and safety of Cangrelor in the subgroup of patients who received unfractionated heparin (UFH) during PCI in the modified intention-to-treat population of the randomized CHAMPION PHOENIX trial (Cangrelor vs clopidogrel; n = 10,939). The primary efficacy end point was the composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis (ST) at 48 hours. The key secondary efficacy end point was ST. UFH was used in 69.2% (7,569/10,939) of patients. In the UFH subgroup, Cangrelor reduced the primary composite efficacy end point at 48 hours compared with clopidogrel (4.8% vs 5.9%; odds ratio [OR] 0.80 [0.65 to 0.98]; p = 0.03). Cangrelor consistently reduced ST at 2 hours (0.7% vs 1.3%; OR 0.56 [0.35 to 0.90]; p = 0.01) and 48 hours (0.9% vs 1.4%; OR 0.70 [0.45 to 1.07]; p = 0.10). There was no difference in GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries)-defined severe or life-threatening bleeding (0.1% vs 0.1%; OR 1.24 [0.33 to 4.61]; p = 0.75) or blood transfusion requirement at 48 hours (0.4% vs 0.2%; OR 1.87 [0.83 to 4.21]; p = 0.12). In conclusion, Cangrelor reduces early ischemic periprocedural complications without increasing severe bleeding compared with clopidogrel in patients undergoing PCI with UFH.

  • Cangrelor reduces the risk of ischemic complications in patients with single vessel and multi vessel disease undergoing percutaneous coronary intervention insights from the champion phoenix trial
    American Heart Journal, 2017
    Co-Authors: Freddy Abnousi, Gregg W. Stone, Jayne Prats, Christian W. Hamm, Efthymios N Deliargyris, Celina M Yong, Vandana Sundaram, Philippe Gabriel Steg, C. Michael Gibson
    Abstract:

    Objective To examine the safety and efficacy of Cangrelor in patients with single-vessel disease (SVD) and multi-vessel disease (MVD). Background Cangrelor, an intravenous, rapidly acting P2Y 12 inhibitor, is superior to clopidogrel in reducing ischemic events among patients receiving percutaneous coronary intervention (PCI). Methods We studied a modified intention to treat population of patients with SVD and MVD from the CHAMPION PHOENIX trial. The primary efficacy outcome was the composite of death, myocardial infarction (MI), ischemia-driven revascularization (IDR), and stent thrombosis (ST) at 48hours. The key safety outcome was non–coronary artery bypass grafting GUSTO severe bleeding at 48hours. Results Among 10,921 patients, 5,220 (48%) had SVD and 5,701 (52%) had MVD. MVD patients were older and more often had diabetes, hyperlipidemia, hypertension, prior stroke, and prior MI. After adjustment, MVD patients had similar rates of 48-hour death/MI/IDR/ST (6.3% vs 4.2%, adjusted odds ratio [OR] 1.6 [95% CI 0.42-6.06]) and GUSTO severe bleeding (0.1% vs 0.2%, P =.67) compared with SVD patients. Consistent with overall trial findings, Cangrelor use reduced ischemic complications in patients with both SVD (3.9% vs 4.5%; OR 0.86, 95% CI 0.65-1.12) and MVD (5.5% vs 7.2%; OR 0.74, 95% CI 0.6-0.92, P -interaction=.43). GUSTO severe bleeding outcomes were not significantly increased with Cangrelor or clopidogrel in either SVD or MVD patients. Conclusion In the CHAMPION PHOENIX trial, MVD and SVD patients had similar ischemic outcomes at 48hours and 30days. Cangrelor consistently reduced ischemic complications in both SVD and MVD patients without a significant increase in GUSTO severe bleeding. Clinical perspectives What's known? Cangrelor is a novel, intravenous, potent, and rapidly acting P2Y 12 inhibitor that has been demonstrated to reduce the rate of ischemic events at 48hours in patients who received PCI compared with clopidogrel. What's new? In contrast to prior studies, we found that in this modern cohort, patients with SVD and MVD had a similar risk of ischemic complications and GUSTO severe bleeding after PCI. We also found that Cangrelor consistently reduced ischemic complications in both SVD and MVD patients without a significant increase in GUSTO severe bleeding. What's next? To assess the impact of single vessel PCI versus multivessel PCI in patients with SVD and MVD.

  • Cangrelor versus clopidogrel on a background of unfractionated heparin insights from champion phoenix
    Journal of the American College of Cardiology, 2017
    Co-Authors: Muthiah Vaduganathan, Gregg W. Stone, Jayne Prats, Michael C Gibson, Robert A Harrington, Christian W. Hamm, Efthymios N Deliargyris, Philippe Gabriel Steg, Matthew Price, Kenneth W Mahaffey
    Abstract:

    Background: Cangrelor is approved for use during percutaneous coronary intervention (PCI) and is administered with different intravenous anticoagulants. Methods: We examined the efficacy and safety of Cangrelor in the subgroup of patients who received unfractionated heparin for PCI in the mITT

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  • the efficacy and safety of Cangrelor for patients undergoing single vessel versus multi vessel percutaneous coronary intervention insights from the champion phoenix trial
    Journal of the American College of Cardiology, 2018
    Co-Authors: Christoph B Olivier, Gregg W. Stone, Matthew J Price, Michael C Gibson, Ph. Gabriel Steg, Freddy Abnousi, Vandana Sundaram, Jaden Yang, Christian Hamm, Efthymios N Deliargyris
    Abstract:

    The intravenous, rapidly acting P2Y12 inhibitor Cangrelor reduces the rate of ischemic events during percutaneous coronary intervention (PCI) with no significant increase in severe bleeding. This study aimed to evaluate the efficacy and safety of Cangrelor in patients treated with single vessel (SV

  • Cangrelor versus clopidogrel on a background of unfractionated heparin insights from champion phoenix
    Journal of the American College of Cardiology, 2017
    Co-Authors: Muthiah Vaduganathan, Gregg W. Stone, Jayne Prats, Michael C Gibson, Robert A Harrington, Christian W. Hamm, Efthymios N Deliargyris, Philippe Gabriel Steg, Matthew Price, Kenneth W Mahaffey
    Abstract:

    Background: Cangrelor is approved for use during percutaneous coronary intervention (PCI) and is administered with different intravenous anticoagulants. Methods: We examined the efficacy and safety of Cangrelor in the subgroup of patients who received unfractionated heparin for PCI in the mITT

  • evaluation of ischemic and bleeding risks associated with 2 parenteral antiplatelet strategies comparing Cangrelor with glycoprotein iib iiia inhibitors an exploratory analysis from the champion trials
    JAMA Cardiology, 2017
    Co-Authors: Muthiah Vaduganathan, Gregg W. Stone, Matthew J Price, Michael C Gibson, Robert A Harrington, Ph. Gabriel Steg, Christian W. Hamm, Efthymios N Deliargyris, Alberto Menozzi, Jayne Prats
    Abstract:

    Importance In the context of contemporary pharmacotherapy, optimal antiplatelet management with percutaneous coronary intervention (PCI) has not been well established. Objective To compare the ischemic and bleeding risks associated with glycoprotein IIb/IIIa inhibitors (GPIs) and a potent P2Y 12 antagonist, Cangrelor, in patients undergoing PCI. Design, Setting, and Participants An exploratory analysis of pooled patient-level data from the 3 phase 3 Cangrelor vs Standard Therapy to Achieve Optimal Management of Platelet Inhibition (CHAMPION PCI, CHAMPION PLATFORM, and CHAMPION PHOENIX) trials of patients undergoing elective or nonelective PCI. The participants included 10 929 patients assigned to Cangrelor but not receiving GPIs (Cangrelor alone) and 1211 patients assigned to clopidogrel (or placebo) and receiving routine GPIs (clopidogrel-GPI). Patients requiring bailout or rescue GPI therapy were excluded. To account for risk imbalances, 1:1 propensity score matching based on 16 baseline clinical variables yielded 1021 unique matched pairs. The present study’s data analysis was conducted from October 28, 2015, to August 6, 2016. Main Outcomes and Measures The primary efficacy end point was the composite of all-cause mortality, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours. Safety was assessed by 3 validated bleeding scales (Global Use of Strategies to Open Occluded Coronary Arteries [GUSTO], Thrombolysis in Myocardial Infarction [TIMI], and Acute Catheterization and Urgent Intervention Triage) and requirement for blood transfusions. Results Of the 12 140 patients included in the analysis, 8779 were men (72.3%), and the mean (SD) age was 63.2 (11.3) years. Patients in the clopidogrel-GPI group were more likely to be male (75.6% vs 71.9%), younger (median, 60 [range, 23-91] years vs 64 [range, 26-95] years), enrolled from the United States (77.9% vs 40.0%), and present with an acute coronary syndrome, but they had lower comorbid disease burden and were less likely to receive bivalirudin (8.8% vs 27.3%). In the matched cohorts, the rates of the primary efficacy end point were not significantly different between the Cangrelor alone and clopidogrel-GPI groups (2.6% vs 3.3%; odds ratio [OR], 0.79; 95% CI, 0.48-1.32). There was a nonsignificant trend toward lower rates of GUSTO-defined severe/life-threatening bleeding with Cangrelor alone compared with clopidogrel-GPI (0.3% vs 0.7%; OR, 0.43; 95% CI, 0.11-1.66). Rates of TIMI-defined major or minor bleeding were significantly lower in patients treated with Cangrelor alone (0.7% vs 2.4%; OR, 0.29; 95% CI, 0.13-0.68). Conclusions and Relevance Based on a pooled analysis from the 3 phase 3 CHAMPION trials, Cangrelor alone was associated with similar ischemic risk and lower risk-adjusted bleeding risk compared with clopidogrel-GPIs. Trial Registration clinicaltrials.gov Identifiers:NCT00305162,NCT00385138, andNCT01156571

  • efficacy and safety of Cangrelor in preventing periprocedural complications in patients with stable angina and acute coronary syndromes undergoing percutaneous coronary intervention the champion phoenix trial
    Jacc-cardiovascular Interventions, 2016
    Co-Authors: Jeremie Abtan, Gregg W. Stone, Gabriel P Steg, Kenneth W Mahaffey, Matthew J Price, Jayne Prats, Michael C Gibson, Christian W. Hamm, Freddy Abnousi, Efthymios N Deliargyris
    Abstract:

    Abstract Objectives The purpose of this study was to examine the safety and efficacy of Cangrelor in patients with stable angina (SA) or acute coronary syndrome (ACS). Background The CHAMPION PHOENIX (A Clinical Trial Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who Require Percutaneous Coronary Intervention) trial demonstrated that Cangrelor significantly reduced periprocedural ischemic events in all-comer percutaneous coronary intervention with a modest increase in mild and moderate bleeding. Whether this benefit is consistent across SA and ACS has not been explored fully. Methods The CHAMPION PHOENIX trial compared periprocedural administration of Cangrelor or clopidogrel, with either a 300- or 600-mg loading dose for the prevention of periprocedural complications in patients undergoing percutaneous coronary intervention. Among the 10,942 patients in the modified intention to treat population, 6,358 patients were classified as having SA, and 4,584 patients had ACS (including unstable angina, non ST-segment elevation myocardial infarction and ST-segment elevation myocardial infarction) at randomization. The primary composite endpoint was death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 h. A key secondary endpoint was stent thrombosis, and the primary safety endpoint was GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) severe bleeding. Results Cangrelor consistently reduced the primary endpoint in SA and ACS (odds ratio [OR]: 0.83 [95% confidence interval (CI): 0.67 to 1.01] and OR: 0.71 [95% CI: 0.52 to 0.96], respectively; interaction p = 0.41). Cangrelor also consistently reduced stent thrombosis in SA and ACS (OR: 0.55 [95% CI: 0.30 to 1.01] and OR: 0.67 [95% CI: 0.42 to 1.06], respectively; interaction p = 0.62). The impact of Cangrelor on GUSTO severe/moderate bleeding was also similar for SA and ACS (OR: 1.49 [95% CI: 0.67 to 3.33] and OR: 1.79 [95% CI: 0.79 to 4.07], respectively; interaction p = 0.75). Conclusions The benefits and risks of Cangrelor were consistent in patients with SA and ACS. (A Clinical Trial Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who Require Percutaneous Coronary Intervention [PCI] [CHAMPION PHOENIX] [CHAMPION]; NCT01156571)

  • variation in patient profiles and outcomes in us and non us subgroups of the Cangrelor versus standard therapy to achieve optimal management of platelet inhibition champion phoenix trial
    Circulation-cardiovascular Interventions, 2016
    Co-Authors: Muthiah Vaduganathan, Gregg W. Stone, Matthew J Price, Jayne Prats, Michael C Gibson, Robert A Harrington, Ph. Gabriel Steg, Christian W. Hamm, Efthymios N Deliargyris, Kenneth W Mahaffey
    Abstract:

    Background— The Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition (CHAMPION) PHOENIX trial demonstrated superiority of Cangrelor in reducing ischemic events at 48 hours in patients undergoing percutaneous coronary intervention compared with clopidogrel. Methods and Results— We analyzed all patients included in the modified intention-to-treat analysis in US (n=4097; 37.4%) and non-US subgroups (n=6845; 62.6%). The US cohort was older, had a higher burden of cardiovascular risk factors, and had more frequently undergone prior cardiovascular procedures. US patients more frequently underwent percutaneous coronary intervention for stable angina (77.9% versus 46.2%). Almost all US patients (99.1%) received clopidogrel loading doses of 600 mg, whereas 40.5% of non-US patients received 300 mg. Bivalirudin was more frequently used in US patients (56.7% versus 2.9%). At 48 hours, rates of the primary composite end point were comparable in the US and non-US cohorts (5.5% versus 5.2%; P =0.53). Cangrelor reduced rates of the primary composite end point compared with clopidogrel in US (4.5% versus 6.4%; odds ratio 0.70 [95% confidence interval 0.53–0.92]) and in non-US patients (4.8% versus 5.6%; odds ratio 0.85 [95% confidence interval 0.69–1.05]; interaction P =0.26). Similarly, rates of the key secondary end point, stent thrombosis, were reduced by Cangrelor in both regions. Rates of Global Use of Strategies to Open Occluded Arteries (GUSTO)–defined severe bleeding were low and not significantly increased by Cangrelor in either region. Conclusions— Despite broad differences in clinical profiles and indications for percutaneous coronary intervention by region in a large global cardiovascular clinical trial, Cangrelor consistently reduced rates of ischemic end points compared with clopidogrel without an excess in severe bleeding in both the US and non-US subgroups. Clinical Trial Registration— URL: . Unique identifier: [NCT01156571][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01156571&atom=%2Fcirccvint%2F9%2F6%2Fe003612.atom

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