Effect of platelet inhibition with cangrelor during PCI on ischemic events
Deepak L Bhatt, Gregg W Stone, Kenneth W Mahaffey, C Michael Gibson, P Gabriel Steg, Christian W Hamm, Matthew J Price, Sergio Leonardi, Dianne Gallup, Ezio Bramucci, Peter W Radke, Petr Widimský, Frantisek Tousek, Jeffrey Tauth, Douglas Spriggs, Brent T McLaurin, Dominick J Angiolillo, Philippe Généreux, Tiepu Liu, Jayne Prats, Meredith Todd, Simona Skerjanec, Harvey D White, Robert A Harrington, CHAMPION PHOENIX Investigators, Deepak L Bhatt, Robert A Harrington, C Michael Gibson, Christian W Hamm, Kenneth W Mahaffey, Matthew J Price, Gabriel Steg, Gregg W Stone, Harvey D White, Kurt Huber, Valter C Lima, Julia B Jorgova-Makedonska, Petr Widimský, Bondo Kobulia, Peter W Radke, Ezio Bramucci, Adam Witkowski, Evgeny Shlyakhto, Frans Van de Werf, David P Faxon, E Magnus Ohman, Freek W A Verheugt, W Douglas Weaver, Jan G P Tijssen, Kenneth W Mahaffey, Sergio Leonardi, Matthew Wilson, Stacey Mangum, Renato D Lopes, Chiara Melloni, Matthew J Brennan, Pierluigi Tricoci, Robert Harrison, Pedro Barros, Luciana Armaganijan, Monique Anderson, Akshay Bagai, Philippe Généreux, Sorin J Brener, Laura LaSalle, Werner Benzer, Georg Delle-Karth, Kurt Huber, Franz Leisch, Jamil Abdalla Saad, Alexandre Abizaid, Carlos Augusto Formiga Areas, Expedito E Ribeiro, Fabio Rossi Dos Santos, Rogerio Tadeu Tumelero, Roberto Vieira Botelho, Borislav Atzev, Boicho Boichev, Georgi Grigorov, Nikolay Penkov, Ivo Petrov, Boris Zehirov, Pavel Cervinka, Zdenek Coufal, Petr Hajek, David Horak, Petr Kala, Petr Kmonicek, Viktor Kocka, Jan Mrozek, Stanislav Simek, Jan Sitar, Josef Stasek, Frantisek Tousek, Gulnara Chapidze, Nodar Emukhvari, George Khabeishvili, Merab Mamatsashvili, Tamaz Shaburishvili, Steffen Behrens, Harald Darius, Martin Dissmann, Stephan Fichtlscherer, Wolfgang Franz, Tobias Geisler, Sabine Genth-Zotz, Britta Goldmann, Hubertus Heuer, Stefan Hoffmann, Andreas Mugge, Tudor Poerner, Peter Radke, Gert Richardt, Christoph Stellbrink, Nikos Werner, Ezio Bramucci, Stefano De Servi, Gennaro Galasso, Alberto Menozzi, Giuseppe Musumeci, Andrea Picchi, Patrizia Presbitero, Gerard Devlin, Alexander Sasse, Douglas Scott, Ralph Stewart, Szyszka Andrzej, Witold Dubaniewicz, Zbigniew Gasior, Jaroslaw Kasprzak, Andrzej Kleinrok, Zdzislawa Kornacewicz-Jach, Andrzej Rynkiewicz, Cezary Sosnowski, Radoslaw Targonski, Jaroslaw Trebacz, Adam Witkowski, Elzbieta Zinka, Olga Barbarash, Yakov Dovgalevsky, Ivan Gordeev, Svetlana Kalinina, Elena Kosmachova, Kirill Linev, Valentin Markov, Prokhor Pavlov, Sergey Shalaev, Zaur Shogenov, Irina Sukmanova, Elena Vasilieva, Alexey Yakovlev, Sarana Boonbaichaiyapruck, Noppadol Chamnarnphol, Pinij Kaewsuwanna, Srun Kuanprasert, Dilok Piyayotai, Maged Amine, Dominick Angiolillo, Imran Arif, James Blankenship, Emmanouil Brilakis, Michael Chan, Joseph Cinderella, Brent Davis, Chandanreddy Devireddy, Mark Dorogy, John Douglas, Norman Ferrier, Daniel Fisher, Robert Foster, William French, John Galla, Lawrence Gimple, Harinder Gogia, Prospero Gogo, Raghava Gollapudi, Luis Gruberg, James Hermiller, Richard Heuser, Robert Iwaoka, Zubair Jafar, Carey Kimmelstiel, Scott Kinlay, James Leggett, Pierre Leimgruber, Dustin Letts, Michael Lipsitt, Reginald Low, Joaquin Martinez-Arraras, Marc Mayhew, Brent McLaurin, Paul McWhirter, Ayoub Mirza, Brian Negus, Thomas Nygaard, William O'Riordan, Richard Paulus, John Petersen, Hector Picon, Mark Picone, Matthew Price, Ernesto Rivera, David Rizik, David Rizik, Arsenio Rodriguez, Jorge Saucedo, J Christopher Scott, Virender Sethi, Adhir Shroff, Craig Siegel, Douglas Spriggs, Daniel Steinberg, Michael Stillabower, Thomas Stuckey, Jose Suarez, Jeffrey Tauth, Dogan Temizer, Mladen Vidovich, Michele Voeltz, Jonathan Waltman, Michael Wilensky, Deepak L Bhatt, Gregg W Stone, Kenneth W Mahaffey, C Michael Gibson, P Gabriel Steg, Christian W Hamm, Matthew J Price, Sergio Leonardi, Dianne Gallup, Ezio Bramucci, Peter W Radke, Petr Widimský, Frantisek Tousek, Jeffrey Tauth, Douglas Spriggs, Brent T McLaurin, Dominick J Angiolillo, Philippe Généreux, Tiepu Liu, Jayne Prats, Meredith Todd, Simona Skerjanec, Harvey D White, Robert A Harrington, CHAMPION PHOENIX Investigators, Deepak L Bhatt, Robert A Harrington, C Michael Gibson, Christian W Hamm, Kenneth W Mahaffey, Matthew J Price, Gabriel Steg, Gregg W Stone, Harvey D White, Kurt Huber, Valter C Lima, Julia B Jorgova-Makedonska, Petr Widimský, Bondo Kobulia, Peter W Radke, Ezio Bramucci, Adam Witkowski, Evgeny Shlyakhto, Frans Van de Werf, David P Faxon, E Magnus Ohman, Freek W A Verheugt, W Douglas Weaver, Jan G P Tijssen, Kenneth W Mahaffey, Sergio Leonardi, Matthew Wilson, Stacey Mangum, Renato D Lopes, Chiara Melloni, Matthew J Brennan, Pierluigi Tricoci, Robert Harrison, Pedro Barros, Luciana Armaganijan, Monique Anderson, Akshay Bagai, Philippe Généreux, Sorin J Brener, Laura LaSalle, Werner Benzer, Georg Delle-Karth, Kurt Huber, Franz Leisch, Jamil Abdalla Saad, Alexandre Abizaid, Carlos Augusto Formiga Areas, Expedito E Ribeiro, Fabio Rossi Dos Santos, Rogerio Tadeu Tumelero, Roberto Vieira Botelho, Borislav Atzev, Boicho Boichev, Georgi Grigorov, Nikolay Penkov, Ivo Petrov, Boris Zehirov, Pavel Cervinka, Zdenek Coufal, Petr Hajek, David Horak, Petr Kala, Petr Kmonicek, Viktor Kocka, Jan Mrozek, Stanislav Simek, Jan Sitar, Josef Stasek, Frantisek Tousek, Gulnara Chapidze, Nodar Emukhvari, George Khabeishvili, Merab Mamatsashvili, Tamaz Shaburishvili, Steffen Behrens, Harald Darius, Martin Dissmann, Stephan Fichtlscherer, Wolfgang Franz, Tobias Geisler, Sabine Genth-Zotz, Britta Goldmann, Hubertus Heuer, Stefan Hoffmann, Andreas Mugge, Tudor Poerner, Peter Radke, Gert Richardt, Christoph Stellbrink, Nikos Werner, Ezio Bramucci, Stefano De Servi, Gennaro Galasso, Alberto Menozzi, Giuseppe Musumeci, Andrea Picchi, Patrizia Presbitero, Gerard Devlin, Alexander Sasse, Douglas Scott, Ralph Stewart, Szyszka Andrzej, Witold Dubaniewicz, Zbigniew Gasior, Jaroslaw Kasprzak, Andrzej Kleinrok, Zdzislawa Kornacewicz-Jach, Andrzej Rynkiewicz, Cezary Sosnowski, Radoslaw Targonski, Jaroslaw Trebacz, Adam Witkowski, Elzbieta Zinka, Olga Barbarash, Yakov Dovgalevsky, Ivan Gordeev, Svetlana Kalinina, Elena Kosmachova, Kirill Linev, Valentin Markov, Prokhor Pavlov, Sergey Shalaev, Zaur Shogenov, Irina Sukmanova, Elena Vasilieva, Alexey Yakovlev, Sarana Boonbaichaiyapruck, Noppadol Chamnarnphol, Pinij Kaewsuwanna, Srun Kuanprasert, Dilok Piyayotai, Maged Amine, Dominick Angiolillo, Imran Arif, James Blankenship, Emmanouil Brilakis, Michael Chan, Joseph Cinderella, Brent Davis, Chandanreddy Devireddy, Mark Dorogy, John Douglas, Norman Ferrier, Daniel Fisher, Robert Foster, William French, John Galla, Lawrence Gimple, Harinder Gogia, Prospero Gogo, Raghava Gollapudi, Luis Gruberg, James Hermiller, Richard Heuser, Robert Iwaoka, Zubair Jafar, Carey Kimmelstiel, Scott Kinlay, James Leggett, Pierre Leimgruber, Dustin Letts, Michael Lipsitt, Reginald Low, Joaquin Martinez-Arraras, Marc Mayhew, Brent McLaurin, Paul McWhirter, Ayoub Mirza, Brian Negus, Thomas Nygaard, William O'Riordan, Richard Paulus, John Petersen, Hector Picon, Mark Picone, Matthew Price, Ernesto Rivera, David Rizik, David Rizik, Arsenio Rodriguez, Jorge Saucedo, J Christopher Scott, Virender Sethi, Adhir Shroff, Craig Siegel, Douglas Spriggs, Daniel Steinberg, Michael Stillabower, Thomas Stuckey, Jose Suarez, Jeffrey Tauth, Dogan Temizer, Mladen Vidovich, Michele Voeltz, Jonathan Waltman, Michael Wilensky
Abstract
Background: The intensity of antiplatelet therapy during percutaneous coronary intervention (PCI) is an important determinant of PCI-related ischemic complications. Cangrelor is a potent intravenous adenosine diphosphate (ADP)-receptor antagonist that acts rapidly and has quickly reversible effects.
Methods: In a double-blind, placebo-controlled trial, we randomly assigned 11,145 patients who were undergoing either urgent or elective PCI and were receiving guideline-recommended therapy to receive a bolus and infusion of cangrelor or to receive a loading dose of 600 mg or 300 mg of clopidogrel. The primary efficacy end point was a composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours after randomization; the key secondary end point was stent thrombosis at 48 hours. The primary safety end point was severe bleeding at 48 hours.
Results: The rate of the primary efficacy end point was 4.7% in the cangrelor group and 5.9% in the clopidogrel group (adjusted odds ratio with cangrelor, 0.78; 95% confidence interval [CI], 0.66 to 0.93; P=0.005). The rate of the primary safety end point was 0.16% in the cangrelor group and 0.11% in the clopidogrel group (odds ratio, 1.50; 95% CI, 0.53 to 4.22; P=0.44). Stent thrombosis developed in 0.8% of the patients in the cangrelor group and in 1.4% in the clopidogrel group (odds ratio, 0.62; 95% CI, 0.43 to 0.90; P=0.01). The rates of adverse events related to the study treatment were low in both groups, though transient dyspnea occurred significantly more frequently with cangrelor than with clopidogrel (1.2% vs. 0.3%). The benefit from cangrelor with respect to the primary end point was consistent across multiple prespecified subgroups.
Conclusions: Cangrelor significantly reduced the rate of ischemic events, including stent thrombosis, during PCI, with no significant increase in severe bleeding. (Funded by the Medicines Company; CHAMPION PHOENIX ClinicalTrials.gov number, NCT01156571.).
Source: PubMed