Cangrelor Reduces Early MI Events After PCI Initiation

Cangrelor compared to clopidogrel in patients undergoing PCI
Cangrelor compared to clopidogrel in patients undergoing PCI

WASHINGTON, DC—At the ACC.17 Scientific Session, study authors from the University of North Carolina and Brigham and Women's Hospital presented that treatment with cangrelor reduced the early ischemic events seen in the CHAMPION PHOENIX trial, when compared to clopidogrel. 

At 48 hours, cangrelor decreased death, myocardial infarction (SCAI definition), ischemia-driven revascularization (IDR), or stent thrombosis (ARC-ST) in patients undergoing percutaneous coronary intervention (PCI) in the trial. A team of researchers, led by Matthew Cavender, aimed to establish the timing of events to describe the effects of cangrelor. 

Patients undergoing PCI (n=11,145) were randomized at the time of angiography to receive either cangrelor or clopidogrel. The incidence of events that occurred included in the composite endpoint of death, MI, IDR, or ARC-ST were grouped in 2-hour windows from randomization based on investigator-reported times.

A total of 270 ischemic events occurred in the first 48 hours, of which 171 (63.3%) occurred during the first 2 hours. "The majority were MI (44%), and 7% were ARC-ST, 7% IDR, and 5% death," reported Cavender.

In the period from 2 to 6 hours vs. the first 2 peri-procedural hours, overall events decreased by 73%. Cangrelor was found to significantly decrease the events of the composite endpoint in the first 2 hours when compared to clopidogrel (56 vs. 115, risk ratio [RR] 0.47, 95% CI: 0.35–0.67; P<0.001). 

The study found no excess of events in the cangrelor cohort during the 2–6 hours post-PCI transition period to oral clopidogrel when compared to patients given clopidogrel at the time of PCI (26 vs. 21). 

Cavender and coauthors concluded, "In the CHAMPION PHOENIX trial, the majority of events were MIs that occurred in the first 2 hours after the start of PCI. Treatment with cangrelor, when compared to clopidogrel, reduced these early ischemic events."