Cangrelor reduces ischemic events vs. clopidogrel early after PCI
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Treatment with the IV P2Y12 inhibitor cangrelor reduced the number of early ischemic events after PCI, primarily MI and stent thrombosis, compared with oral clopidogrel, according to the results of the CHAMPION PHOENIX trial.
Researchers reported in Circulation: Cardiovascular Interventions that cangrelor reduced the number of ischemic events that occurred within 2 hours following PCI by approximately 25% compared with clopidogrel.
“Patients undergoing PCI are at risk of activation of the clotting process, formation of intravascular thrombus and subsequent myocardial infarction,” Matthew A. Cavender, MD, MPH, interventional cardiologist and assistant professor of medicine in the division of cardiology at University of North Carolina School of Medicine, and colleagues wrote. “As such, adjunctive pharmacology used at the time of PCI is designed to prevent thrombus formation by inhibiting both platelet activation and thrombin formation.”
Trial design and primary endpoints
As Healio previously reported, CHAMPION PHOENIX was a double-blind trial that enrolled 11,145 patients undergoing PCI, and in the main results, cangrelor (Kengreal, Chiesi) outperformed clopidogrel for the primary efficacy endpoint of death, MI, ischemia-driven revascularization or stent thrombosis at 48 hours and the primary safety endpoint of severe bleeding.
For the present analysis, researchers characterized the timing, incidence and type of thrombotic events that occurred in the 2 hours following PCI among patients assigned to IV cangrelor compared with oral clopidogrel. In addition to the primary efficacy endpoint, researchers also evaluated a secondary post hoc composite endpoint of death, Society of Coronary Angiography and Intervention (SCAI) MI, ischemia-driven revascularization or Academic Research Consortium definite stent thrombosis.
Cangrelor vs. clopidogrel post-PCI
According to the study, 63% of events occurred within 2 hours of trial randomization.
The most common early events were MI, followed by stent thrombosis, ischemia-driven revascularization and death.
Researchers reported that, during the first 2 hours after PCI, cangrelor reduced the incidence of the primary endpoint by 24% compared with clopidogrel (5.4% vs. 4.1%; HR = 0.76; 95% CI, 0.64-0.9; P = .002). Findings for the secondary post hoc composite endpoint were similar (1.6% vs. 0.9%; HR = 0.57; 95% CI, 0.4-0.8; P = .001).
Moreover, the benefit of cangrelor was driven by early reductions in SCAI MI (1.4% vs. 0.8%; HR = 0.59; 95% CI, 0.4-0.85; P = .004) and stent thrombosis at 2 hours (1.3% vs. 0.7%; HR = 0.53; 95% CI, 0.35-0.79; P = .001).
Early moderate or severe non-CABG bleeding events were infrequent, and there was no difference between the two groups (0.2% vs. 0.1%; adjusted OR = 1.41; 95% CI, 0.37-5.4; P = .62).
Researchers found no interaction between the benefit with cangrelor and index indication for PCI (P for interaction = .98).
“The angiographic core-lab analysis from CHAMPION PHOENIX (the largest to date) showed that benefits were present in acute coronary syndrome, as well as non-acute coronary syndrome patients, especially when the latter group had high risk angiographic features,” the researchers wrote.
Researchers observed no difference in occurrence of the primary composite endpoint between the cangrelor or clopidogrel groups after the initial 2 hours following PCI (0.6% vs. 0.5%; OR = 1.17; 95% CI, 0.71-1.93; P = .53).
“The reductions in ischemic events, and thus, the overall efficacy seen with cangrelor in this exploratory analysis of CHAMPION PHOENIX occurred early and during the period of time in which patients were being actively treated with cangrelor,” the researchers wrote. “These findings affirm the feasibility of the transition strategy for procedural cangrelor to oral maintenance P2Y12 inhibition and provide evidence that supports the importance of potent platelet inhibition during PCI.”
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