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Cangrelor compared with clopidogrel in patients with prior myocardial infarction - Insights from the CHAMPION trials.

Abstract：

BACKGROUND:Patients who have had a prior myocardial infarction (MI) are at increased risk for adverse outcomes after subsequent percutaneous coronary intervention (PCI). OBJECTIVE:The objective of this study is to examine the efficacy and safety of cangrelor, a potent intravenous P2Y12 inhibitor, in patients with prior MI. METHODS:Pooled data from the CHAMPION trials were examined. Prior MI was defined as a history of MI, excluding MI events at baseline. The primary endpoint was a composite of death, MI, ischemia-driven revascularization, or stent thrombosis at 48-h post-randomization. The primary safety endpoint was GUSTO-defined severe bleeding at 48h. RESULTS:Out of 24,691 patients, 5699 (23%) had a prior MI. The primary endpoint was higher in patients with vs. without prior MI (4.9% vs. 4.0%, p=0.002). The primary endpoint was 4.2% with cangrelor vs. 5.7% with clopidogrel (absolute risk reduction=1.5%; OR 0.72 [95%CI 0.57-0.92]) in patients with prior MI and 3.7% with cangrelor vs. 4.3% with clopidogrel (absolute risk reduction=0.6%; OR 0.85 [95%CI 0.74-0.99]) in patients without prior MI (P-interaction=0.25). The rate of GUSTO-defined severe bleeding was 0.1% with cangrelor vs. 0.1% with clopidogrel (OR 1.39 [95%CI 0.31-6.24]) in patients with prior MI, and 0.2% with cangrelor vs. 0.2% with clopidogrel (OR 1.18 [95%CI 0.65-2.14]) in patients without prior MI (P-interaction=0.84). CONCLUSION:In the CHAMPION trials, patients with prior MI had higher rates of ischemic outcomes within 48h after PCI. Cangrelor reduced ischemic events with no significant increase in GUSTO-defined severe bleeding in patients with or without prior MI.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Eisen A,Harrington RA,Stone GW,Steg PG,Gibson CM,Hamm CW,Price MJ,Prats J,Deliargyris EN,Mahaffey KW,White HD,Bhatt DL,CHAMPION Investigators.

doi

10.1016/j.ijcard.2017.10.006

subject

Has Abstract

pub_date

2018-01-01 00:00:00

pages

49-55

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(17)31405-5

journal_volume

250

pub_type

杂志文章,随机对照试验

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Cangrelor compared with clopidogrel in patients with prior myocardial infarction - Insights from the CHAMPION trials.