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Cangrelor yields similar results vs. clopidogrel in patients with stroke, TIA before PCI
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Among patients with a previous cerebrovascular event at least 1 year before PCI, compared with clopidogrel, cangrelor delivered an efficacy and bleeding profile similar to that of the overall trial, according to recent findings.
In the study, researchers evaluated patients who were enrolled in the CHAMPION studies. The CHAMPION studies were three randomized, double blind, double dummy trials comparing cangrelor (Kengreal, The Medicines Company) and clopidogrel during PCI in 24,910 patients.
In the present study, the researchers identified a subgroup of 1,270 patients (5.1%) with a history of cerebrovascular events at least 1 year before randomization. The researchers used the Breslow-Day test to evaluate interaction of treatment effect in this subgroup compared with the 23,546 patients without history of a cerebrovascular event at least 1 year before randomization.
The primary efficacy endpoint was a composite of death, MI, ischemia-driven revascularization or stent thrombosis at 48 hours.
Of the 1,270 patients who had a cerebrovascular event (stroke or transient ischemic attack) at least 1 year before randomization, 650 were assigned to cangrelor and 620 were assigned to clopidogrel.
Patients with a history of cerebrovascular event more than 1 year before PCI were generally older, and had a higher percentage of diabetes, hypertension, dyslipidemia, congestive HF, MI, peripheral artery disease and CABG vs. those without a history of a cerebrovascular event, according to Neal N. Sawlani, MD, MPH, from the Brigham and Women’s Hospital Heart and Vascular Center and Harvard Medical School, and colleagues.
Among those with a prior cerebrovascular event, the primary efficacy endpoint occurred in 4.3% of those assigned cangrelor and 5.3% of those assigned clopidogrel (OR = 0.8; 95% CI, 0.48-1.34; P for interaction = .97), and GUSTO severe bleeding occurred in 0.3% of both groups (P = .97; P for interaction = .81); both figures were consistent with the overall trial, Sawlani and colleagues wrote.
The researchers found no statistically significant difference in the 48-hour primary efficacy outcome between patients with history of a cerebrovascular event more than 1 year previously vs. those without a cerebrovascular event (4.8% vs. 4.2%; OR = 1.14; 95% CI, 0.89-1.47).
Patients with a history of previous stroke or TIA had a 17.1% rate of any 48-hour GUSTO bleeding vs. 15.4% in the rest of the pooled population (OR = 1.13; 95% CI, 0.98-1.32).
“In patients with a prior stroke or [TIA] undergoing [PCI] with cangrelor, there is no difference in the rate of severe bleeding compared with clopidogrel,” the researchers wrote. “In patients with a stroke or [TIA] > 1 year prior who are undergoing [PCI] with cangrelor or clopidogrel, the rate of intracranial hemorrhage is low.” – by Jennifer Byrne
Disclosure: The study was supported by The Medicines Company. Sawlani reports no relevant financial disclosures. Please see the full study for a list of the other researchers’ relevant financial disclosures.
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