CHAMPION: Does Cangrelor Improve Periprocedural Outcomes in PCI?

Intravenous cangrelor given at the time of PCI significantly reduced the risk of periprocedural thrombotic complications up to 30 days as compared to clopidogrel or placebo, according to results of the CHAMPION Study presented on Sept. 3 as part of the ESC Congress 2013.

“If approved [in the U.S.] in addition to the superiority that we saw, there’s this convenience factor. This is a fast onset/fast offset intravenous potent agent so it doesn’t have the limitations or liabilities of an oral antiplatelet,” said Deepak Bhatt, MD, FACC.

The study, an analysis of patient level data from CHAMPION-PCI, CHAMPION-PLATFORM and CHAMPION-PHOENIX trial, focused on patients undergoing PCI for STEMI, non-ST-elevation acute coronary syndromes and stable coronary artery disease.

Findings from the study show that cangrelor reduced the odds of death, myocardial infarction or ischemia-driven revascularization by 19 percent (3.8 percent for cangrelor vs. 4.7 percent for control). It also reduced the odds of stent thrombosis by 41 percent (0.5 percent for cangrelor vs. 0.8 percent for control). According to the study investigators, efficacy outcomes were consistent across the trials and primary patient subsets and these benefits were maintained at 30 days.

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In terms of bleeding, cangrelor did not increase the risk of severe bleeding events or increase the rate of transfusions. However, the rates of less severe bleeding events were increased in patients given the drug. The risk of transient dyspnea was also increased, but the authors note that this occurred in only 0.1 percent of patients.

The findings from this trial could be of benefit to patients undergoing PCI and receiving oral platelet P2Y12 inhibitors or in patients in whom only short-term antiplatelet effect is desirable. While the study authors note that the CHAMPION trials did not test cangrelor against prasugrel, ticagrelor or clopidogrel pre-treatment before PCI, they suggest that cangrelor's greater potency than clopidogrel, increased speed of onset compared to all oral ADP receptor antagonists and its added flexibility given its rapidly reversible effects, could be of benefit to these patients – particularly those waiting to undergo open-heart surgery.

Keywords: Coronary Artery Disease, Myocardial Infarction, Acute Coronary Syndrome, Thrombosis, Blood Platelets, Dyspnea, Cardiac Surgical Procedures, Purinergic P2Y Receptor Antagonists, Stents

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