Cangrelor is an intravenous P2Y12 inhibitor approved to reduce peri-procedural ischemic events in patients undergoing PCI that have not previously received any other P2Y12 inhibitor.
The CHAMPION PHOENIX trial randomized a total of 11,145 patients to cangrelor vs. clopidogrel.
The study sought to explore the effect of cangrelor on peri-procedural acute myocardial infarction (AMI) according to different definitions.
462 patients (4.2%) undergoing PCI presented acute MI according to the 2nd universal definition. The vast majority of these infarctions were type 4A (n=433, 93.7%).
Treatment with cangrelor reduced MI incidence at 48 hrs. (3.8% vs. 4.7%; OR 0.80; CI 95%, 0.67-0.97; p=0.02).
When the SCAI definition of peri-procedural MI was applied, there were fewer MI (n=134). In addition, the effect of cangrelor remained significant (OR, 0.65; CI 95%, 0.46-0.92; p=0.01).
A similar effect of cangrelor was observed when MI was defined as peak CK-MB≥ 10x ULN (OR, 0.64; CI 95%I, 0.45-0.91) or when MI was defined with this same enzyme elevation but associated to ECG changes or ischemic symptoms (OR, 0.63; CI 95%, 0.48-0.84).
Any of the above definitions of MI were associated with an increased risk of death at 30 days.
Cangrelor administration reduced:
- The composite death point of death.
- MI (SCAI definition).
- Ischemia driven target lesion revascularization or definite stent thrombosis (1.4% vs 2.1%; OR 0.69; 95% 0.51-0.92).
Conclusion
Peri-procedural MI in patients undergoing PCI continues to be associated to increased death risk, regardless MI definition. Cangrelor, compared to clopidogrel, significantly reduces MI rate.
Original Title: Consistent Reduction in Peri-Procedural Myocardial Infarction with Cangrelor as Assessed by Multiple Definitions: Findings from CHAMPION PHOENIX. Cangrelor Reduces MI in Patients Undergoing PCI.
Reference: Cavender et al. 10.1161/CIRCULATIONAHA.115.020829.
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