Efficacy and Safety of Cangrelor in Preventing Periprocedural Complications in Patients With Stable Angina and Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: The CHAMPION PHOENIX Trial

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• 作者：Jé ; ré ; mie Abtan ; MD^a ; P. Gabriel Steg ; MD^a ; ^b ; ^{gabriel.steg@bch.aphp.fr" class="auth_mail" title="E-mail the corresponding author} ; Gregg W. Stone ; MD^c ; Kenneth W. Mahaffey ; MD^d ; C. Michael Gibson ; MD^e ; Christian W. Hamm ; MD^f ; Matthew J. Price ; MD^g ; Freddy Abnousi ; MD ; MBA ; MSc^g ; Jayne Prats ; PhD^h ; Efthymios N. Deliargyris ; MD^h ; Harvey D. White ; DScⁱ ; Robert A. Harrington ; MD^d ; Deepak L. Bhatt ; MD ; MPH^j ; on behalf of the CHAMPION PHOENIX Investigators^&lowast ;
• 关键词：ACS ; Cangrelor ; CHAMPION PHOENIX ; PCI ; stable angina
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：26 September 2016
• 年：2016
• 卷：9
• 期：18
• 页码：1905-1913
• 全文大小：687 K

文摘

The purpose of this study was to examine the safety and efficacy of cangrelor in patients with stable angina (SA) or acute coronary syndrome (ACS).

Background

The CHAMPION PHOENIX (A Clinical Trial Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who Require Percutaneous Coronary Intervention) trial demonstrated that cangrelor significantly reduced periprocedural ischemic events in all-comer percutaneous coronary intervention with a modest increase in mild and moderate bleeding. Whether this benefit is consistent across SA and ACS has not been explored fully.

Methods

The CHAMPION PHOENIX trial compared periprocedural administration of cangrelor or clopidogrel, with either a 300- or 600-mg loading dose for the prevention of periprocedural complications in patients undergoing percutaneous coronary intervention. Among the 10,942 patients in the modified intention to treat population, 6,358 patients were classified as having SA, and 4,584 patients had ACS (including unstable angina, non ST-segment elevation myocardial infarction and ST-segment elevation myocardial infarction) at randomization. The primary composite endpoint was death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 h. A key secondary endpoint was stent thrombosis, and the primary safety endpoint was GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) severe bleeding.

Results

Cangrelor consistently reduced the primary endpoint in SA and ACS (odds ratio [OR]: 0.83 [95% confidence interval (CI): 0.67 to 1.01] and OR: 0.71 [95% CI: 0.52 to 0.96], respectively; interaction p = 0.41). Cangrelor also consistently reduced stent thrombosis in SA and ACS (OR: 0.55 [95% CI: 0.30 to 1.01] and OR: 0.67 [95% CI: 0.42 to 1.06], respectively; interaction p = 0.62). The impact of cangrelor on GUSTO severe/moderate bleeding was also similar for SA and ACS (OR: 1.49 [95% CI: 0.67 to 3.33] and OR: 1.79 [95% CI: 0.79 to 4.07], respectively; interaction p = 0.75).

Conclusions

The benefits and risks of cangrelor were consistent in patients with SA and ACS. (A Clinical Trial Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who Require Percutaneous Coronary Intervention [PCI] [CHAMPION PHOENIX] [CHAMPION]; w/NCT01156571?term=NCT01156571&rank=1">NCT01156571)