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IMPACT OF PRIOR CEREBROVASCULAR EVENTS ON ISCHEMIC AND BLEEDING OUTCOMES WITH CANGRELOR IN PERCUTANEOUS CORONARY INTERVENTION
198 JACC April 5, 2016 Volume 67, Issue 13
ACC.i2 Interventional Cardiology IMPACT OF PRIOR CEREBROVASCULAR EVENTS ON ISCHEMIC AND BLEEDING OUTCOMES WITH CANGRELOR IN PERCUTANEOUS CORONARY INTERVENTION Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 9:45 a.m.-10:30 a.m. Session Title: Anti Thrombotic New Theraputic Approaches Abstract Category: 1. ACC.i2 Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology Presentation Number: 1174-114 Authors: Neal Narain Sawlani, Robert Harrington, Gregg Stone, Philippe Steg, C. Michael Gibson, Christian Hamm, Matthew Price, Jayne Prats, Efthymios Deliargyris, Kenneth Mahaffey, Harvey White, Deepak L. Bhatt, Brigham and Women’s Hospital, Boston, MA, USA
Background: Cangrelor is a potent intravenous adenosine diphosphate (ADP)-receptor antagonist that reduces the 48-hour and 30day rates of ischemic events during percutaneous coronary intervention (PCI) without an increase in severe bleeding. Certain oral ADP antagonists are contraindicated in patients with previous cerebrovascular events. We therefore sought to evaluate the benefits and risks of cangrelor use in patients with prior ischemic stroke or transient ischemic attack (TIA).
Methods: CHAMPION PHOENIX was a randomized, double blind, placebo-controlled trial comparing cangrelor with clopidogrel during PCI. The effect of cangrelor on ischemic events and bleeding was analyzed in the subgroup of patients with a history of ischemic stroke or TIA at least one year prior to randomization. The primary efficacy end point was a composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours. The primary safety end point was Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) defined severe bleeding at 48 hours. Results: Among the 11,145 randomized patients, 527 (275 received cangrelor; 252 received clopidogrel) had a prior cerebrovascular event. Consistent with the overall trial results, the rate of the primary efficacy end point was 5.2% in the cangrelor group versus 6.6% in the clopidogrel group (odds ratio [OR] 0.78; 95% CI, 0.37-1.63; P = 0.50; P for interaction = 0.97), and the rate of the primary safety endpoint of GUSTO severe bleeding was 0.4% in both groups (P = 0.95; P for interaction = 0.71). Furthermore, there was no significant difference in the rate of any blood product transfusion between the two groups (0.4% vs 0.8%; OR 0.46; 95% CI, 0.04-5.06; P = 0.51; P for interaction = 0.27). There was one non-fatal intracranial hemorrhage in the cangrelor group. Conclusions: Among patients in CHAMPION PHOENIX with a cerebrovascular event at least one year prior to PCI, the efficacy and bleeding profile of cangrelor compared with clopidogrel was similar to that in the overall trial. There did not appear to be a heightened bleeding risk in this subgroup known to be at elevated risk of bleeding.
ACC.i2 Interventional Cardiology IMPACT OF PRIOR CEREBROVASCULAR EVENTS ON ISCHEMIC AND BLEEDING OUTCOMES WITH CANGRELOR IN PERCUTANEOUS CORONARY INTERVENTION Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 9:45 a.m.-10:30 a.m. Session Title: Anti Thrombotic New Theraputic Approaches Abstract Category: 1. ACC.i2 Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology Presentation Number: 1174-114 Authors: Neal Narain Sawlani, Robert Harrington, Gregg Stone, Philippe Steg, C. Michael Gibson, Christian Hamm, Matthew Price, Jayne Prats, Efthymios Deliargyris, Kenneth Mahaffey, Harvey White, Deepak L. Bhatt, Brigham and Women’s Hospital, Boston, MA, USA
Background: Cangrelor is a potent intravenous adenosine diphosphate (ADP)-receptor antagonist that reduces the 48-hour and 30day rates of ischemic events during percutaneous coronary intervention (PCI) without an increase in severe bleeding. Certain oral ADP antagonists are contraindicated in patients with previous cerebrovascular events. We therefore sought to evaluate the benefits and risks of cangrelor use in patients with prior ischemic stroke or transient ischemic attack (TIA).
Methods: CHAMPION PHOENIX was a randomized, double blind, placebo-controlled trial comparing cangrelor with clopidogrel during PCI. The effect of cangrelor on ischemic events and bleeding was analyzed in the subgroup of patients with a history of ischemic stroke or TIA at least one year prior to randomization. The primary efficacy end point was a composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours. The primary safety end point was Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) defined severe bleeding at 48 hours. Results: Among the 11,145 randomized patients, 527 (275 received cangrelor; 252 received clopidogrel) had a prior cerebrovascular event. Consistent with the overall trial results, the rate of the primary efficacy end point was 5.2% in the cangrelor group versus 6.6% in the clopidogrel group (odds ratio [OR] 0.78; 95% CI, 0.37-1.63; P = 0.50; P for interaction = 0.97), and the rate of the primary safety endpoint of GUSTO severe bleeding was 0.4% in both groups (P = 0.95; P for interaction = 0.71). Furthermore, there was no significant difference in the rate of any blood product transfusion between the two groups (0.4% vs 0.8%; OR 0.46; 95% CI, 0.04-5.06; P = 0.51; P for interaction = 0.27). There was one non-fatal intracranial hemorrhage in the cangrelor group. Conclusions: Among patients in CHAMPION PHOENIX with a cerebrovascular event at least one year prior to PCI, the efficacy and bleeding profile of cangrelor compared with clopidogrel was similar to that in the overall trial. There did not appear to be a heightened bleeding risk in this subgroup known to be at elevated risk of bleeding.