title: A novel approach to systematically implement the universal definition of myocardial infarction: insights from the CHAMPION PLATFORM trial.
abstract: OBJECTIVE
  To reassess the efficacy of cangrelor efficacy using the universal definition of myocardial infarction (MI).
  
  
  METHODS
  We adopted a novel approach to systematically implement the universal definition of MI. Two physicians blinded to treatment allocation reviewed plots of CK-MB and troponin values in relation to time of randomisation and percutaneous coronary intervention (PCI) to identify patients with stable or falling biomarkers pre-PCI (ie, primary cohort), and those with post-PCI CK-MB elevations.
  
  
  METHODS
  The CHAMPION PLATFORM trial.
  
  
  METHODS
  Non-ST-elevation acute coronary syndromes (95%) and stable angina patients (5%).
  
  
  METHODS
  Cangrelor versus placebo.
  
  
  METHODS
  The efficacy of cangrelor compared with placebo using the reclassified events (type 4a MI) and the original clinical events committee-adjudicated (CEC PCI-MI) results was investigated.
  
  
  RESULTS
  Of 5295 patients, 3406 (64.4%) were in the primary cohort. Type 4a MI occurred in 4.3% (226 events/5295 patients) while original CEC PCI-MI occurred in 6.5% (344 events/5295 patients), a significant difference (p<0.0001). Using the reclassified MI events, the primary composite endpoint of death, MI, or ischaemia-driven revascularisation through 48 h occurred in 5.4% of patients (4.9% cangrelor, 6.0% placebo; OR 0.80; 95% CI 0.63 to 1.02) as opposed to 7.5% of the primary analyses (7.0% cangrelor, 8.0% placebo; OR 0.87; 95% CI 0.71 to 1.07).
  
  
  CONCLUSIONS
  Systematic, strict implementation of the universal MI definition with emphasis on baseline assessment may enhance discrimination in detecting PCI-MI and may allow for more rigorous assessment of interventions in patients undergoing early PCI.
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA. sergio.leonardi@duke.edu
authors: Sergio
authors: S
authors: Leonardi
authors: Adriano A M
authors: AA
authors: Truffa
authors: Megan L
authors: ML
authors: Neely
authors: Pierluigi
authors: P
authors: Tricoci
authors: Harvey D
authors: HD
authors: White
authors: C Michael
authors: CM
authors: Gibson
authors: Matthew
authors: M
authors: Wilson
authors: Gregg W
authors: GW
authors: Stone
authors: Robert A
authors: RA
authors: Harrington
authors: Deepak L
authors: DL
authors: Bhatt
authors: Kenneth W
authors: KW
authors: Mahaffey
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000249:Adenosine Monophosphate / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000032:analysis*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D058921:Purinergic P2Y Receptor Antagonists; D014336:Troponin; D000249:Adenosine Monophosphate; C117446:cangrelor; D052279:Creatine Kinase, MB Form