Open AccessThe efficacy and safety of cangrelor in single vessel vs multivessel percutaneous coronary intervention: Insights from CHAMPION PHOENIX
Author(s) -
Yong Celina M.,
Sundaram Vandana,
Abnousi Freddy,
Olivier Christoph B.,
Yang Jaden,
Stone Gregg W.,
Steg Philippe G.,
Michael Gibson C.,
Hamm Christian W.,
Price Matthew J.,
Deliargyris Efthymios N.,
Prats Jayne,
White Harvey D.,
Harrington Robert A.,
Bhatt Deepak L.,
Mahaffey Kenneth W.
Publication year - 2019
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.23221
Subject(s) - cangrelor , medicine , conventional pci , percutaneous coronary intervention , clopidogrel , cardiology , myocardial infarction , stroke (engine) , p2y12 , anesthesia , mechanical engineering , engineering
Abstract Background The 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. Methods We 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. Hypothesis Cangrelor is as efficacious and safe as clopidogrel in both SV and MV PCI. Results Among 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. Conclusions In 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.