Evaluating Cangrelor Vs Clopidogrel In Percutaneous Coronary Intervention

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Study results were consistent across populations with stable angina, NSTE-ACS, and STEMI.
Study results were consistent across populations with stable angina, NSTE-ACS, and STEMI.

WASHINGTON, DC — At the 66th Annual Scientific Session & Expo of the American College of Cardiology, researchers from Brigham and Women's Hospital Heart & Vascular Center, Boston, MA, reported that cangrelor, a rapidly-acting, potent, reversible platelet P2Y12ADP antagonist, reduced early ischemic periprocedural complications without an increase in severe bleeding compared to clopidogrel in patients undergoing percutaneous coronary intervention (PCI) on a background of heparin.

During PCI, cangrelor is indicated for use with different intravenous (IV) anticoagulants. Lead author, Muthiah Vaduganathan, and coauthors studied the safety and efficacy of cangrelor in a subgroup of patients receiving unfractionated heparin for PCI in the modified intent-to-treat (mITT) population of the CHAMPION PHOENIX trial (n=10,939). 

"The primary efficacy endpoint was the composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48h," explained Vaduganathan. Stent thrombosis (ST) was the key secondary efficacy endpoint. 

Of the total studied patients, heparin was used in 69.2% (n=7,566) of patients. PCI was performed for stable angina (55.6%), non-ST elevation acute coronary syndrome (NSTE-ACS; 26.6%), or ST-elevation myocardial infarction (STEMI; 17.8%). 

Among patients in the unfractionated heparin group, cangrelor decreased the primary composite efficacy endpoint at 48h vs. clopidogrel (4.8% vs 5.9%, odds ratio [OR]: 0.80, 95% CI, 0.65–0.98; =.03). Cangrelor also consistently reduced ST at 48h (0.9% vs 1.4%, OR: 0.70, 95% CI, (0.45–1.07; =.10). 

No difference was seen in GUSTO severe/life-threatening bleeding vs. placebo (0.1% vs 0.1%, OR: 1.24, 95% CI, 0.33–4.61; =.75) or in requiring blood transfusion at 48h (0.4% vs 0.2%, OR: 1.87, 95% CI, 0.83–4.21; =.12). Vaduganathan added, "Results were consistent in stable angina, NSTE-ACS, and STEMI." 

Reference

Vaduganathan M, Harrington R, Stone G, et al. Impact of periprocedural myocardial infarction in contemporary PCI: pooled patient-level data from the CHAMPION trials. Abstract No. 1166-320. Presented at: American College of Cardiology 2017 Scientific Sessions; March 17-19, 2017; Washington, DC.

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