Cangrelor compared with clopidogrel in patients with prior myocardial infarction – Insights from the CHAMPION trials. (1st January 2018)

• Record Type: Journal Article
• Authors: Eisen, Alon; Harrington, Robert A.; Stone, Gregg W.; Steg, Ph. Gabriel; Gibson, C. Michael; Hamm, Christian W.; Price, Matthew J.; Prats, Jayne; Deliargyris, Efthymios N.; Mahaffey, Kenneth W.; White, Harvey D.; Bhatt, Deepak L.
• Is Part Of: International journal of cardiology. Volume 250(2018)
• Page Start: 49
• Page End: 55
• Publication Date: 2018-01-01
• Subjects: CV cardiovascular events -- CABG coronary artery bypass graft -- GUSTO Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries -- HF heart failure -- LVEF left ventricular ejection fraction -- MI myocardial infarction -- NSTE-ACS non-ST-segment elevation acute coronary syndrome -- PCI percutaneous coronary intervention -- ST stent thrombosis -- STEMI ST-segment elevation myocardial infarction -- TIMI thrombolysis in myocardial infarction; Prior myocardial infarction -- Antiplatelet therapy -- Cangrelor -- Percutaneous coronary intervention -- Stent thrombosis; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.10.006
• Languages: English
• ISSNs: 0167-5273

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 P2Y12 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 48 h. 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 48 h after PCI. Cangrelor reduced ischemic events with no significant increase in GUSTO-defined severe bleeding in patients with or without prior MI.