Among patients undergoing percutaneous coronary intervention (PCI), the periprocedural benefits and risk of bleeding with cangrelor were similar for patients with stable angina and for those with acute coronary syndrome (ACS), according to a study published in JACC: Cardiovascular Interventions.

Clopidogrel is widely used in combination with aspirin to prevent periprocedural complications in patients undergoing PCI. But it has a slow onset and offset of action and variable antiplatelet effect, and often cannot be administered effectively in acute ST-elevated myocardial infarction (STEMI) or cardiac arrest due to its oral-only formulation.

Cangrelor, a reversible P2Y12 inhibitor, was shown to be effective at preventing periprocedural complications with PCI in the CHAMPION PHOENIX trial. “Intravenous cangrelor is a potentially useful option in patients undergoing PCI. It provides an immediate, high degree of platelet inhibition and reduces complications of PCI, including stent thrombosis,” Deepak L. Bhatt, MD, MPH of Brigham and Women’s Hospital Heart & Vascular Center told Cardiology Advisor.


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But because the periprocedural risks of PCI may be different for SA than they are for ACS, Dr Bhatt and fellow investigators compared the risks and benefits of cangrelor in stable angina with those in ACS in the CHAMPION PHOENIX trial.

In CHAMPION PHOENIX, cangrelor was compared with clopidogrel as periprocedural antiplatelet therapy, and the rates of periprocedural complications were assessed. The primary composite end point was defined as all-cause death, MI, ischemia-driven revascularization, or stent thrombosis  at 48 hours. The primary safety end point was severe bleeding at 48 hours, as measured by the GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) scale.

A total of 6358 patients with stable angina and 4584 patients with ACS were evaluated. Patients treated with cangrelor experienced similar reductions in the primary end point whether the indication for PCI was stable angina(odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.67-1.01) or ACS (OR: 0.71; 95% CI: 0.52-0.96; interaction P =.41).

The ability of cangrelor to prevent stent thrombosis was also similar in patients with stable angina (OR: 0.55; 95% CI: 0.30-1.01) and those with ACS (OR: 0.67; 95% CI: 0.42-1.06; interaction P =.62). Meanwhile, clopidogrel had stent thrombosis incidence rates of 0.9% in the stable angina group and 2.0% in the ACS group.

No significant difference in the risk of GUSTO severe/moderate bleeding was found for the stable angina and ACS subgroups (ORs: 1.49; 95% CI: 0.67-3.33 and 1.79; 95% CI: 0.79-4.07, respectively; interaction P= .75). Overall, the rates of GUSTO severe/moderate bleeding were low among patients with stable angina (cangrelor: 0.5% vs clopidogrel: 0.3%)  and among patients with ACS (cangrelor: 0.7% vs clopidogrel 0.4%; interaction P= .75). “The short half-life of cangrelor appears to minimize major bleeding complications,” Dr Bhatt noted.

“The benefits and safety profile of antiplatelet therapy with intravenous cangrelor were similar in PCI patients with ACS and in PCI patients with stable angina,” Dr Bhatt concluded. “This illustrates the importance of potent platelet inhibition across the full spectrum of PCI, not just in patients with thrombotic lesions.”

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Disclosures: This study was funded by The Medicines Company. Dr Bhatt has received research funding from Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Medtronic, Pfizer, Roche, Sanofi, and The Medicines Company (including for his role as co-chair of CHAMPION PHOENIX), and serves on various other advisory boards and committees. The other authors reported similar disclosures.

For more information on the CHAMPION PHOENIX trial, please visit the trial page at ClinicalTrials.gov. 

Reference

Abtan J, Steg PG, Stone GW, et al; CHAMPION PHOENIX Investigators. 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 Cardiovasc Interv. 2016;9(18):1905-1913. doi: 10.1016/j.jcin.2016.06.046.