The efficacy and safety of cangrelor in single vessel vs multivessel percutaneous coronary intervention: Insights from CHAMPION PHOENIX.

Celina M Yong,Vandana Sundaram,Philippe G Steg,Christian W Hamm,Freddy Abnousi,Jaden Yang,Robert A Harrington,Harvey D White,C Michael Gibson,Gregg W Stone,Kenneth W Mahaffey,Deepak L Bhatt,Jayne Prats,Christoph B Olivier,Matthew J Price,Efthymios N Deliargyris

doi:10.1002/clc.23221

Abstract

BackgroundThe intravenous, rapidly acting P2Y12 inhibitor cangrelor reduces the rate of ischemic events during PCI with no significant increase in severe bleeding. However, the efficacy and safety of cangrelor compared with clopidogrel in patients treated with single vessel (SV)‐percutaneous coronary intervention (PCI) or multivessel (MV)‐PCI remains unexplored.MethodsWe studied the modified intention‐to‐treat population of patients from the CHAMPION PHOENIX trial who were randomized to either cangrelor or clopidogrel. We used logistic regression and propensity score matching to evaluate the effect of cangrelor compared with clopidogrel on the primary efficacy outcome (composite of death, myocardial infarction, ischemia‐driven revascularization, or stent thrombosis) at 48 hours. The safety outcome was moderate or severe Global Utilization of Streptokinase and tPA for Occluded Arteries bleeding at 48 hours.HypothesisCangrelor is as efficacious and safe as clopidogrel in both SV and MV PCI.ResultsAmong 10 854 patients, 9204 (85%) underwent SV‐ and 1650 (15%) MV‐PCI. After adjustment, cangrelor was associated with similar reductions vs clopidogrel in the primary efficacy outcome in patients undergoing SV‐PCI (4.5% vs 5.2%; odds ratio [OR] 0.81 [0.66‐0.98]) or MV‐PCI (6.1% vs 9.8%, OR 0.59 [0.41‐0.85]; Pint 0.14). Similar results were observed after propensity score matching (SV‐PCI: 5.5% vs 5.9%, OR 0.93 [0.74‐1.18]; MV‐PCI: 6.2% vs 8.9%, OR 0.67 [0.44‐1.01]; Pint 0.17). There was no evidence of heterogeneity in the treatment effect of cangrelor compared with clopidogrel for the safety outcome.ConclusionsIn patients undergoing SV‐ or MV‐PCI, cangrelor was associated with similar relative risk reductions in ischemic complications and no increased risk of significant bleeding compared with clopidogrel, which highlights the expanding repertoire of options for use in complex PCI.

Highlights

Rapid advances in percutaneous coronary intervention (PCI) tools and techniques are allowing operators to tackle progressively more challenging coronary revascularization procedures via a percutaneous approach
We aimed to evaluate the efficacy and safety of cangrelor compared with clopidogrel among patients treated with single vessel percutaneous coronary intervention (SV-PCI) or with multivessel percutaneous coronary intervention (MV-PCI) in the CHAMPION PHOENIX trial
This study is the first to provide two notable findings: (a) cangrelor was associated with a similar reduction in risk of death/myocardial infarction (MI)/ischemia-driven revascularization (IDR)/stent thrombosis (ST) compared with clopidogrel among patients treated with single vessel (SV)- vs MVPCI, with consistent results after adjustment and propensity matching, (b) cangrelor was not associated with an increase in the risk of moderate or severe bleeding compared with clopidogrel among patients treated with SV- vs MV-PCI

Summary

| INTRODUCTION

Rapid advances in percutaneous coronary intervention (PCI) tools and techniques are allowing operators to tackle progressively more challenging coronary revascularization procedures via a percutaneous approach. MV-PCI is associated with increased complexity and risk.[2,3]. The CHAMPION PHOENIX trial evaluated the efficacy and safety of cangrelor compared with clopidogrel among patients undergoing PCI for indications ranging from stable angina to all forms of acute coronary syndrome. Cangrelor reduced the rate of ischemic events at 48 hours compared with clopidogrel, without a significant increase in severe bleeding.[4]. The efficacy and safety of cangrelor compared with clopidogrel was similar in patients with single vessel (SV)-disease and in patients with MV-disease.[5]. The risks and benefits of MV-PCI as a revascularization strategy in combination with either cangrelor or clopidogrel are still unknown. We aimed to evaluate the efficacy and safety of cangrelor compared with clopidogrel among patients treated with SV-PCI or with MV-PCI in the CHAMPION PHOENIX trial

| Participants

| RESULTS

| DISCUSSION

Findings

CONFLICT OF INTEREST