Optimizing the Use of Cangrelor in the Real World

Arman Qamar; Deepak L. Bhatt


Am J Cardiovasc Drugs. 2017;17(1):5-16. 

In This Article

Geographic Region and Outcomes in Champion Phoenix

Globalization of clinical trials has led to enrollment of patients from different regions of the world. Regional variation in patient characteristics, race, ethnicity, lifestyle, health-care delivery, and practice patterns may preclude the generalizability of the trial results to all geographic regions.[67,68] CHAMPION PHOENIX included 11,145 patients from 153 sites from 12 countries, with approximately 40 % of the patients from the USA. In a prespecified subgroup analysis in CHAMPION PHOENIX, Vaduganathan et al. examined the effect of cangrelor on efficacy and safety end points in patients enrolled in US and non-US sites.[69] There was significant heterogeneity in demographics, patient characteristics, periprocedural medication therapy, and indications for PCI among patients enrolled in US versus non-US sites. However, despite these differences, the beneficial effect of cangrelor on efficacy and safety end points did not differ significantly by geographic regions. In patients enrolled in the USA, the rate of the primary efficacy end point of death, MI, IDR, or stent thrombosis was lower in the cangrelor group compared with the clopidogrel group (4.5 vs. 6.4 %) (odds ratio 0.70; 95 % CI 0.53–0.92). Likewise, the rate of the primary end point was lower in patients treated with cangrelor than clopidogrel in patients outside the USA (4.8 vs. 5.6 %) (odds ratio 0.85; 95 % CI 0.69–1.05; P interaction = 0.26). In addition, cangrelor reduced the rates of stent thrombosis in both US (0.5 vs. 1.3 %) (odds ratio 0.38; 95 % CI 0.18–0.79) and non-US cohorts (1.1 vs. 1.4 %) (odds ratio 0.75; 95 % CI 0.48–1.15; P interaction = 0.12). Consistent with the overall trial results, there were no significant differences in the rates of the primary safety end points between the cangrelor and clopidogrel treatment arms in the US and non-US cohorts.