Cangrelor bests clopidogrel for stent thrombosis

Thrombus

Credit: Andre E.X. Brown

WASHINGTON, DC—A new analysis suggests cangrelor can reduce the risk of stent thrombosis in patients undergoing percutaneous coronary intervention (PCI), when compared to clopidogrel.

In fact, cangrelor was an independent predictor of freedom from stent thrombosis at 30 days after PCI.

These results, obtained by analyzing patients from the CHAMPION PHOENIX trial, were presented at the American College of Cardiology’s 63rd Annual Scientific Session & Expo (presentation 2105-290).

CHAMPION PHOENIX was a prospective, double-blind trial that included 11,145 patients. They were randomized to receive intravenous cangrelor or oral clopidogrel at the time of PCI.

In a previous analysis of the trial data, researchers found that cangrelor reduced the overall odds of complications from stenting procedures—including death, myocardial infarction, ischemia-driven revascularization, and stent thrombosis—compared to clopidogrel. However, cangrelor also increased the risk of major and minor bleeding.

In the new analysis, an independent core laboratory blinded to the treatment performed angiographic analysis in 10,939 of the patients. The researchers defined stent thrombosis as the occurrence of intraprocedural stent thrombosis (IPST) or ARC-defined stent thrombosis (definite or probable).

Stent thrombosis occurred in 120 patients (1.1%) at 48 hours after PCI and in 175 patients (1.6%) at 30 days. The occurrence of stent thrombosis at 48 hours and 30 days was associated with a marked increase in 30-day mortality, with odds ratios (ORs) of 15.3 (P<0.001) and 55.2 (P<0.001), respectively.

IPST, ARC acute stent thrombosis (≤ 24 hrs), and ARC subacute stent thrombosis (1-30 days) occurred in 89 (0.8%), 32 (0.3%), and 60 (0.5%) patients, respectively.

Each type of stent thrombosis was associated with an increase in 30-day mortality. The ORs were 17.4 for IPST (P<0.001), 43.3 for ARC acute stent thrombosis (P<0.001), and 189.1 for ARC subacute stent thrombosis (P<0.001).

“Regardless of the exact type of stent thrombosis, it remains associated with a high rate of death,” said investigator Deepak L. Bhatt, MD, MPH, a professor at Harvard Medical School and co-chair of the CHAMPION program.

However, patients who received cangrelor were less likely than those treated with clopidogrel to develop stent thrombosis, both at 48 hours and at 30 days.

At 48 hours, stent thrombosis had occurred in 0.8% and 1.4% of patients, respectively (P=0.01). And at 30 days, stent thrombosis had occurred in 1.3% and 1.9%, respectively (P=0.01).

Cangrelor appeared to be more effective than clopidogrel at preventing all types of stent thrombosis, although the difference was only statistically significant for IPST.

IPST occurred in 0.6% and 1.0% of patients, respectively (P=0.04). Acute ARC stent thrombosis occurred in 0.2% and 0.4%, respectively (P=0.8). And subacute ARC stent thrombosis occurred in 0.5% and 0.6%, respectively (P=0.60).

Multivariable analysis suggested the use of cangrelor was as an independent predictor of freedom from stent thrombosis at 30 days.

The CHAMPION PHOENIX trial was funded by The Medicines Company, makers of cangrelor.

Thrombus

Credit: Andre E.X. Brown

WASHINGTON, DC—A new analysis suggests cangrelor can reduce the risk of stent thrombosis in patients undergoing percutaneous coronary intervention (PCI), when compared to clopidogrel.

In fact, cangrelor was an independent predictor of freedom from stent thrombosis at 30 days after PCI.

These results, obtained by analyzing patients from the CHAMPION PHOENIX trial, were presented at the American College of Cardiology’s 63rd Annual Scientific Session & Expo (presentation 2105-290).

CHAMPION PHOENIX was a prospective, double-blind trial that included 11,145 patients. They were randomized to receive intravenous cangrelor or oral clopidogrel at the time of PCI.

In a previous analysis of the trial data, researchers found that cangrelor reduced the overall odds of complications from stenting procedures—including death, myocardial infarction, ischemia-driven revascularization, and stent thrombosis—compared to clopidogrel. However, cangrelor also increased the risk of major and minor bleeding.

In the new analysis, an independent core laboratory blinded to the treatment performed angiographic analysis in 10,939 of the patients. The researchers defined stent thrombosis as the occurrence of intraprocedural stent thrombosis (IPST) or ARC-defined stent thrombosis (definite or probable).

Stent thrombosis occurred in 120 patients (1.1%) at 48 hours after PCI and in 175 patients (1.6%) at 30 days. The occurrence of stent thrombosis at 48 hours and 30 days was associated with a marked increase in 30-day mortality, with odds ratios (ORs) of 15.3 (P<0.001) and 55.2 (P<0.001), respectively.

IPST, ARC acute stent thrombosis (≤ 24 hrs), and ARC subacute stent thrombosis (1-30 days) occurred in 89 (0.8%), 32 (0.3%), and 60 (0.5%) patients, respectively.

Each type of stent thrombosis was associated with an increase in 30-day mortality. The ORs were 17.4 for IPST (P<0.001), 43.3 for ARC acute stent thrombosis (P<0.001), and 189.1 for ARC subacute stent thrombosis (P<0.001).

“Regardless of the exact type of stent thrombosis, it remains associated with a high rate of death,” said investigator Deepak L. Bhatt, MD, MPH, a professor at Harvard Medical School and co-chair of the CHAMPION program.

However, patients who received cangrelor were less likely than those treated with clopidogrel to develop stent thrombosis, both at 48 hours and at 30 days.

At 48 hours, stent thrombosis had occurred in 0.8% and 1.4% of patients, respectively (P=0.01). And at 30 days, stent thrombosis had occurred in 1.3% and 1.9%, respectively (P=0.01).

Cangrelor appeared to be more effective than clopidogrel at preventing all types of stent thrombosis, although the difference was only statistically significant for IPST.

IPST occurred in 0.6% and 1.0% of patients, respectively (P=0.04). Acute ARC stent thrombosis occurred in 0.2% and 0.4%, respectively (P=0.8). And subacute ARC stent thrombosis occurred in 0.5% and 0.6%, respectively (P=0.60).

Multivariable analysis suggested the use of cangrelor was as an independent predictor of freedom from stent thrombosis at 30 days.

The CHAMPION PHOENIX trial was funded by The Medicines Company, makers of cangrelor.

Thrombus

Credit: Andre E.X. Brown

WASHINGTON, DC—A new analysis suggests cangrelor can reduce the risk of stent thrombosis in patients undergoing percutaneous coronary intervention (PCI), when compared to clopidogrel.

In fact, cangrelor was an independent predictor of freedom from stent thrombosis at 30 days after PCI.

These results, obtained by analyzing patients from the CHAMPION PHOENIX trial, were presented at the American College of Cardiology’s 63rd Annual Scientific Session & Expo (presentation 2105-290).

CHAMPION PHOENIX was a prospective, double-blind trial that included 11,145 patients. They were randomized to receive intravenous cangrelor or oral clopidogrel at the time of PCI.

In a previous analysis of the trial data, researchers found that cangrelor reduced the overall odds of complications from stenting procedures—including death, myocardial infarction, ischemia-driven revascularization, and stent thrombosis—compared to clopidogrel. However, cangrelor also increased the risk of major and minor bleeding.

In the new analysis, an independent core laboratory blinded to the treatment performed angiographic analysis in 10,939 of the patients. The researchers defined stent thrombosis as the occurrence of intraprocedural stent thrombosis (IPST) or ARC-defined stent thrombosis (definite or probable).

Stent thrombosis occurred in 120 patients (1.1%) at 48 hours after PCI and in 175 patients (1.6%) at 30 days. The occurrence of stent thrombosis at 48 hours and 30 days was associated with a marked increase in 30-day mortality, with odds ratios (ORs) of 15.3 (P<0.001) and 55.2 (P<0.001), respectively.

IPST, ARC acute stent thrombosis (≤ 24 hrs), and ARC subacute stent thrombosis (1-30 days) occurred in 89 (0.8%), 32 (0.3%), and 60 (0.5%) patients, respectively.

Each type of stent thrombosis was associated with an increase in 30-day mortality. The ORs were 17.4 for IPST (P<0.001), 43.3 for ARC acute stent thrombosis (P<0.001), and 189.1 for ARC subacute stent thrombosis (P<0.001).

“Regardless of the exact type of stent thrombosis, it remains associated with a high rate of death,” said investigator Deepak L. Bhatt, MD, MPH, a professor at Harvard Medical School and co-chair of the CHAMPION program.

However, patients who received cangrelor were less likely than those treated with clopidogrel to develop stent thrombosis, both at 48 hours and at 30 days.

At 48 hours, stent thrombosis had occurred in 0.8% and 1.4% of patients, respectively (P=0.01). And at 30 days, stent thrombosis had occurred in 1.3% and 1.9%, respectively (P=0.01).

Cangrelor appeared to be more effective than clopidogrel at preventing all types of stent thrombosis, although the difference was only statistically significant for IPST.

IPST occurred in 0.6% and 1.0% of patients, respectively (P=0.04). Acute ARC stent thrombosis occurred in 0.2% and 0.4%, respectively (P=0.8). And subacute ARC stent thrombosis occurred in 0.5% and 0.6%, respectively (P=0.60).

Multivariable analysis suggested the use of cangrelor was as an independent predictor of freedom from stent thrombosis at 30 days.

The CHAMPION PHOENIX trial was funded by The Medicines Company, makers of cangrelor.