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Cangrelor shows promise in patients with ACS, stable angina undergoing PCI
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Periprocedural use of cangrelor appears to decrease ischemic complications in patients with stable angina and those with ACS undergoing PCI, and does not increase GUSTO severe bleeding in either population, according to recent findings.
Researchers evaluated 10,942 patients in the modified intention-to-treat population of the CHAMPION PHOENIX trial, a double blind, double dummy, placebo-controlled trial that randomly assigned 11,146 patients (median age, 64 years; 28% women) undergoing PCI to either cangrelor (Kengreal, The Medicines Company) bolus and infusion plus oral placebo or placebo bolus and infusion plus oral loading dose of clopidogrel (600 mg or 300 mg) at the time of PCI.
Participants eligible for inclusion in the current analysis were aged at least 18 years and required PCI for stable angina, non-ST-segment elevation ACS or STEMI. Randomization to cangrelor or clopidogrel occurred after angiography before PCI, and was stratified by site, baseline status and intended clopidogrel loading dose.
At randomization, 6,358 patients were categorized as having stable angina and 4,584 had ACS, including unstable angina, non-STEMI and STEMI.
The researchers defined the study’s primary efficacy endpoint as a composite of all-cause mortality, MI, ischemia-driven revascularization or stent thrombosis 48 hours after randomization, with a key secondary endpoint of stent thrombosis at 48 hours. GUSTO severe bleeding was designated as the key safety endpoint.
Reduction across groups
The researchers found that the incidence of the primary composite endpoint of all-cause death, MI, ischemia-driven revascularization or stent thrombosis was reduced in patients with stable angina (OR = 0.83; 95% CI, 0.67-1.01) and ACS (OR = 0.71; 95% CI, 0.52-0.96). Moreover, cangrelor was found to yield a persistent decrease in the key secondary efficacy endpoint of stent thrombosis in stable angina (OR = 0.55; 95% CI, 0.3-1.01) and ACS (OR = 0.67; 95% CI, 0.42-1.06).
The rates of GUSTO severe or moderate bleeding were low overall and, therefore, low and comparable between treatment groups in the stable angina (0.5% for cangrelor vs. 0.3% for clopidogrel; OR = 1.49; 95% CI, 0.67-3.33) and ACS patient subsets (0.7% for cangrelor vs. 0.4% for clopidogrel; OR = 1.79; 95% CI, 0.79-4.07). Notably, no interaction was seen between stable angina and ACS for bleeding regarding the comparison of cangrelor and clopidogrel, according to the researchers.
Encouraging news
In a related editorial, Mathieu Kerneis, MD, and colleagues at the Université Sorbonne Paris 6, ACTION Study Group, Institut de Cardiologie, Pitié-Salpêtrière, Paris, wrote that although cangrelor’s ability to improve patient survival is not proven, these findings are encouraging for the drug’s periprocedural use.
“The authors highlight the fact that the drug effect is consistent in stable CAD patients and ACS patients for ischemic, bleeding and net clinical endpoints, all P values for interaction not being significant,” the researchers wrote. “This is a reassuring finding for cangrelor, opening a wide spectrum of indications for the drug.” – by Jennifer Byrne
Disclosure: The CHAMPION PHOENIX trial was funded by The Medicines Company. Kerneis reports receiving lecture fees from AstraZeneca. Please see the full study for a list of the researchers’ relevant financial disclosures. Please see the full editorial for a list of the other authors’ relevant financial disclosures.
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