title: Effect of platelet inhibition with cangrelor during PCI on ischemic events.
abstract: BACKGROUND
  The intensity of antiplatelet therapy during percutaneous coronary intervention (PCI) is an important determinant of PCI-related ischemic complications. Cangrelor is a potent intravenous adenosine diphosphate (ADP)-receptor antagonist that acts rapidly and has quickly reversible effects.
  
  
  METHODS
  In a double-blind, placebo-controlled trial, we randomly assigned 11,145 patients who were undergoing either urgent or elective PCI and were receiving guideline-recommended therapy to receive a bolus and infusion of cangrelor or to receive a loading dose of 600 mg or 300 mg of clopidogrel. The primary efficacy end point was a composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours after randomization; the key secondary end point was stent thrombosis at 48 hours. The primary safety end point was severe bleeding at 48 hours.
  
  
  RESULTS
  The rate of the primary efficacy end point was 4.7% in the cangrelor group and 5.9% in the clopidogrel group (adjusted odds ratio with cangrelor, 0.78; 95% confidence interval [CI], 0.66 to 0.93; P=0.005). The rate of the primary safety end point was 0.16% in the cangrelor group and 0.11% in the clopidogrel group (odds ratio, 1.50; 95% CI, 0.53 to 4.22; P=0.44). Stent thrombosis developed in 0.8% of the patients in the cangrelor group and in 1.4% in the clopidogrel group (odds ratio, 0.62; 95% CI, 0.43 to 0.90; P=0.01). The rates of adverse events related to the study treatment were low in both groups, though transient dyspnea occurred significantly more frequently with cangrelor than with clopidogrel (1.2% vs. 0.3%). The benefit from cangrelor with respect to the primary end point was consistent across multiple prespecified subgroups.
  
  
  CONCLUSIONS
  Cangrelor significantly reduced the rate of ischemic events, including stent thrombosis, during PCI, with no significant increase in severe bleeding. (Funded by the Medicines Company; CHAMPION PHOENIX ClinicalTrials.gov number, NCT01156571.).
authors.affiliation: VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA 02132, USA. dlbhattmd@post.harvard.edu
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: P Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Price
authors.forename: Sergio
authors.initials: S
authors.lastname: Leonardi
authors.forename: Dianne
authors.initials: D
authors.lastname: Gallup
authors.forename: Ezio
authors.initials: E
authors.lastname: Bramucci
authors.forename: Peter W
authors.initials: PW
authors.lastname: Radke
authors.forename: Petr
authors.initials: P
authors.lastname: Widimský
authors.forename: Frantisek
authors.initials: F
authors.lastname: Tousek
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tauth
authors.forename: Douglas
authors.initials: D
authors.lastname: Spriggs
authors.forename: Brent T
authors.initials: BT
authors.lastname: McLaurin
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.forename: Tiepu
authors.initials: T
authors.lastname: Liu
authors.forename: Jayne
authors.initials: J
authors.lastname: Prats
authors.forename: Meredith
authors.initials: M
authors.lastname: Todd
authors.forename: Simona
authors.initials: S
authors.lastname: Skerjanec
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
mesh_terms: D000249:Adenosine Monophosphate / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D000077144:Clopidogrel; D004311:Double-Blind Method; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D057194:Intention to Treat Analysis; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000401:mortality / Q000517:prevention & control*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000249:Adenosine Monophosphate; C117446:cangrelor; D000077144:Clopidogrel; D013988:Ticlopidine