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

Effect of Cangrelor on Intraprocedural Stent Thrombosis

Intraprocedural stent thrombosis (IPST) is a rare but potentially fatal complication of PCI. IPST is independently associated with subsequent ischemic events and mortality in patients undergoing PCI.[47] Moreover, IPST correlates with development of stent thrombosis according to the Academic Research Consortium (ARC) definition and carries a significant adverse risk, justifying the need to prevent it. In the CHAMPION PHOENIX trial, IPST occurred in approximately 1 % (n = 89) of the study participants.[48] IPST was associated with a significant increase in the risk of adverse ischemic events including, death, MI, IDR, or stent thrombosis at 48 h and at 30 days. In addition, development of IPST resulted in more frequent use of rescue therapy with glycoprotein IIb/IIIa inhibitors, bleeding, and prolongation of hospitalization. In a prespecified angiographic core lab analysis of 10,939 patients—the largest such angiographic analysis to date—treatment with cangrelor reduced the odds of IPST by 35 % (odds ratio 0.65; 95 % CI 0.42–0.99; P = 0.04) compared with clopidogrel at 48 h after randomization. The benefit of cangrelor in reducing IPST was evident irrespective of the clinical presentation as stable angina, NSTE-ACS, or STEMI. Importantly, the use of cangrelor in comparison to clopidogrel at randomization was independently associated with freedom from IPST during PCI.