title: Effect of cangrelor on periprocedural outcomes in percutaneous coronary interventions: a pooled analysis of patient-level data.
abstract: BACKGROUND
  Cangrelor is a potent, rapid-acting, reversible intravenous platelet inhibitor that was tested for percutaneous coronary intervention (PCI) in three large, double-blind, randomised trials. We did a pooled analysis of data from three trials that assessed the effectiveness of cangrelor against either clopidogrel or placebo in PCI.
  
  
  METHODS
  This prespecified, pooled analysis of patient-level data from three trials (CHAMPION-PCI, CHAMPION-PLATFORM, and CHAMPION-PHOENIX) compared cangrelor with control (clopidogrel or placebo) for prevention of thrombotic complications during and after PCI. Trial participants were patients undergoing PCI for ST-elevation myocardial infarction (11.6%), non-ST-elevation acute coronary syndromes (57.4%), and stable coronary artery disease (31.0%). Efficacy was assessed in the modified intention-to-treat population of 24,910 patients, with a prespecified primary efficacy composite of death, myocardial infarction, ischaemia-driven revascularisation, or stent thrombosis at 48 h. The primary safety outcome was non-coronary artery bypass graft-related GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) severe or life-threatening bleeding at 48 h.
  
  
  RESULTS
  Cangrelor reduced the odds of the primary outcome by 19% (3.8% for cangrelor vs 4.7% for control; odds ratio [OR] 0.81, 95% CI 0.71-0.91, p=0.0007), and stent thrombosis by 41% (0.5% vs 0.8%, OR 0.59, 95% CI 0.43-0.80, p=0.0008). Cangrelor reduced the odds of the secondary triple composite (all-cause death, myocardial infarction, or ischaemia-driven revascularisation at 48 h) by 19% (3.6% vs 4.4%, OR 0.81, 95% CI 0.71-0.92, p=0.0014). Efficacy outcomes were consistent across the trials and main patient subsets. These benefits were maintained at 30 days. There was no difference in the primary safety outcome (0.2% in both groups), in GUSTO moderate bleeding (0.6% vs 0.4%), or in transfusion (0.7% vs 0.6%), but cangrelor increased GUSTO mild bleeding (16.8% vs 13.0%, p<0.0001).
  
  
  CONCLUSIONS
  Compared with control (clopidogrel or placebo), cangrelor reduced PCI periprocedural thrombotic complications, at the expense of increased bleeding.
  
  
  BACKGROUND
  The Medicines Company.
authors.affiliation: Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France; Département Hospitalo-Universitaire FIRE, Hôpital Bichat, AP-HP, INSERM U-698, Paris, France. Electronic address: gabriel.steg@bch.aphp.fr.
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Kerckhoff Heart Center, Bad Nauheim, Germany.
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.affiliation: Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY, USA.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: Beth Israel Deaconess Medical Center, Division of Cardiology, Boston, MA, USA.
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.affiliation: Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Leonardi
authors.affiliation: The Medicines Company, Parsippany, NJ, USA.
authors.forename: Tiepu
authors.initials: T
authors.lastname: Liu
authors.affiliation: The Medicines Company, Parsippany, NJ, USA.
authors.forename: Simona
authors.initials: S
authors.lastname: Skerjanec
authors.affiliation: The Medicines Company, Parsippany, NJ, USA.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Day
authors.affiliation: Presbyterian Hospital Cardiac Catheterization Laboratory, Charlotte, NC, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Iwaoka
authors.affiliation: Moses Cone Heart and Vascular Center, Greensboro, NC, USA.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Stuckey
authors.affiliation: Anaheim Memorial Hospital, Anaheim, CA, USA.
authors.forename: Harinder S
authors.initials: HS
authors.lastname: Gogia
authors.affiliation: Stony Brook University Hospital, Health Sciences Center, Stony Brook, NY, USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Gruberg
authors.affiliation: Harbor-UCLA Medical Center, Torrance, CA, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: French
authors.affiliation: Green Lane Cardiovascular Service, Auckland, New Zealand.
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.affiliation: Stanford University Medical School, Stanford, CA, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy; D000249:Adenosine Monophosphate / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D002423:Cause of Death; D003327:Coronary Disease / Q000628:therapy; D004311:Double-Blind Method; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D017202:Myocardial Ischemia / Q000628:therapy*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000249:Adenosine Monophosphate; C117446:cangrelor