In the Journals

Cangrelor appears to benefit patients undergoing PCI

Potential candidates for cangrelor include patients undergoing emergent or urgent PCI who are unable to take oral medications or those who previously underwent a PCI with a drug-eluting stent and require urgent cardiac or noncardiac surgery, according to a meta-analysis published in The American Journal of Cardiology.

CHAMPION trial data

Monil Majmundar, MD, of the department of internal medicine at Metropolitan Hospital Center at New York Medical College, and colleagues analyzed data from 24,910 patients from the CHAMPION PCI, CHAMPION PHOENIX and CHAMPION PLATFORM trials who required PCI. Patients from the CHAMPION PHOENIX and CHAMPION PCI trials had STEMI, stable angina or non-STEMI, whereas those from the CHAMPION PLATFORM trial did not have STEMI.

In all of the trials, patients were assigned cangrelor (Kengreal, Chiesi USA), placebo or clopidogrel. The assigned drug was administered intravenously as a bolus then as an infusion for at least 2 hours or until the PCI was completed. Those assigned cangrelor received 600 mg clopidogrel at the end of the infusion. Clopidogrel was given to patients in the control groups at various points dependent on the trial.

Patients assigned cangrelor had fewer incidences of the clinical efficacy outcomes (death, MI, ischemia-driven revascularization and stent thrombosis) compared with the control group for a reduction of 19% (3.8% vs. 4.7%; OR = 0.81; 95% CI, 0.71-0.91) at 48 hours and 13% at 30 days (5.3% vs. 6.1%; OR = 0.87; 95% CI, 0.78-0.97).

The key secondary outcome of interest — stent thrombosis — was also decreased in patients assigned cangrelor by 41% compared with the control group at 48 hours (0.5% vs. 0.8%; OR = 0.59; 95% CI, 0.43-0.8) and by 31% at 30 days (0.9% vs. 1.3%; OR = 0.69; 95% CI, 0.54-0.88).

The odds of the secondary triple composite outcome of interest, defined as MI, death and ischemia-driven revascularization, were also reduced by 19% in the cangrelor group at 48 hours (3.6% vs. 4.4%; OR = 0.81; 95% CI, 0.71-0.92) and 12% at 30 days (5.1% vs. 5.7%; OR = 0.88; 95% CI, 0.79-0.98).

The risk for a composite of Q-wave MI, death and stent thrombosis was lower in patients assigned cangrelor vs. the control at 48 hours (0.8% vs. 1.3%; OR = 0.63; 95% CI, 0.49-0.81) and 30 days (1.9% vs. 2.4%; OR = 0.81; 95% CI, 0.68-0.96).

Further reduction in outcomes

The benefit of cangrelor contributed to a 32% reduction compared with the control group when the 48-hour primary composite outcome included a combination of Q-wave MI, death and ischemia-driven revascularization (0.8% vs. 1.2%; OR = 0.68; 95% CI, 0.52-0.87). At 48 hours, cangrelor also reduced the odds of MI by 15% (OR = 0.85; 95% CI, 0.74-0.97) and ischemia-driven revascularization by 29% (OR = 0.71; 95% CI, 0.52-0.98). The incidence of death did not differ at 48 hours between patients assigned cangrelor and those assigned the control (0.3% vs. 0.4%, respectively; OR = 0.73; 95% CI, 0.47-1.15).

The benefit of cangrelor at 48 hours for the primary efficacy outcomes was reproducible across all subgroups and irrespectively of the clinical presentation of non-ST elevation ACS, STEMI or stable angina, the researchers wrote.

“It should be kept in mind that cangrelor has not been adequately studied in head-to-head comparisons with more potent P2Y12 inhibitors like ticagrelor and prasugrel,” Majmundar and colleagues wrote. “Whether cangrelor adds clinical benefit to patients treated with these agents is entirely unknown. However, in ACS patients who cannot take oral medications or bridging therapy, cangrelor is still likely to be beneficial.” – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.

Potential candidates for cangrelor include patients undergoing emergent or urgent PCI who are unable to take oral medications or those who previously underwent a PCI with a drug-eluting stent and require urgent cardiac or noncardiac surgery, according to a meta-analysis published in The American Journal of Cardiology.

CHAMPION trial data

Monil Majmundar, MD, of the department of internal medicine at Metropolitan Hospital Center at New York Medical College, and colleagues analyzed data from 24,910 patients from the CHAMPION PCI, CHAMPION PHOENIX and CHAMPION PLATFORM trials who required PCI. Patients from the CHAMPION PHOENIX and CHAMPION PCI trials had STEMI, stable angina or non-STEMI, whereas those from the CHAMPION PLATFORM trial did not have STEMI.

In all of the trials, patients were assigned cangrelor (Kengreal, Chiesi USA), placebo or clopidogrel. The assigned drug was administered intravenously as a bolus then as an infusion for at least 2 hours or until the PCI was completed. Those assigned cangrelor received 600 mg clopidogrel at the end of the infusion. Clopidogrel was given to patients in the control groups at various points dependent on the trial.

Patients assigned cangrelor had fewer incidences of the clinical efficacy outcomes (death, MI, ischemia-driven revascularization and stent thrombosis) compared with the control group for a reduction of 19% (3.8% vs. 4.7%; OR = 0.81; 95% CI, 0.71-0.91) at 48 hours and 13% at 30 days (5.3% vs. 6.1%; OR = 0.87; 95% CI, 0.78-0.97).

The key secondary outcome of interest — stent thrombosis — was also decreased in patients assigned cangrelor by 41% compared with the control group at 48 hours (0.5% vs. 0.8%; OR = 0.59; 95% CI, 0.43-0.8) and by 31% at 30 days (0.9% vs. 1.3%; OR = 0.69; 95% CI, 0.54-0.88).

The odds of the secondary triple composite outcome of interest, defined as MI, death and ischemia-driven revascularization, were also reduced by 19% in the cangrelor group at 48 hours (3.6% vs. 4.4%; OR = 0.81; 95% CI, 0.71-0.92) and 12% at 30 days (5.1% vs. 5.7%; OR = 0.88; 95% CI, 0.79-0.98).

The risk for a composite of Q-wave MI, death and stent thrombosis was lower in patients assigned cangrelor vs. the control at 48 hours (0.8% vs. 1.3%; OR = 0.63; 95% CI, 0.49-0.81) and 30 days (1.9% vs. 2.4%; OR = 0.81; 95% CI, 0.68-0.96).

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Further reduction in outcomes

The benefit of cangrelor contributed to a 32% reduction compared with the control group when the 48-hour primary composite outcome included a combination of Q-wave MI, death and ischemia-driven revascularization (0.8% vs. 1.2%; OR = 0.68; 95% CI, 0.52-0.87). At 48 hours, cangrelor also reduced the odds of MI by 15% (OR = 0.85; 95% CI, 0.74-0.97) and ischemia-driven revascularization by 29% (OR = 0.71; 95% CI, 0.52-0.98). The incidence of death did not differ at 48 hours between patients assigned cangrelor and those assigned the control (0.3% vs. 0.4%, respectively; OR = 0.73; 95% CI, 0.47-1.15).

The benefit of cangrelor at 48 hours for the primary efficacy outcomes was reproducible across all subgroups and irrespectively of the clinical presentation of non-ST elevation ACS, STEMI or stable angina, the researchers wrote.

“It should be kept in mind that cangrelor has not been adequately studied in head-to-head comparisons with more potent P2Y12 inhibitors like ticagrelor and prasugrel,” Majmundar and colleagues wrote. “Whether cangrelor adds clinical benefit to patients treated with these agents is entirely unknown. However, in ACS patients who cannot take oral medications or bridging therapy, cangrelor is still likely to be beneficial.” – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.