Optimizing the Use of Cangrelor in the Real World

Arman Qamar; Deepak L. Bhatt

Disclosures

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

In This Article

Effect of Cangrelor Using Various Definitions of Myocardial Infarction

Various definitions of periprocedural MI exist. A sensitivity analysis examined the effect of cangrelor versus clopidogrel in CHAMPION PHOENIX using several definitions of MI.[49] Of the 11,145 patients in CHAMPION PHOENIX, 4.2 % (n = 421) had an MI as defined by the second universal definition, and 1.2 % had an MI (n = 134) when the Society of Coronary Angiography and Intervention (SCAI) definition of periprocedural MI was used. Occurrence of MI in patients undergoing PCI, irrespective of the definition, was associated with an increased risk of death at 30 days. Treatment with cangrelor resulted in consistent reduction in periprocedural MI regardless of the definition used. At 48 h, MI as defined by the universal definition occurred in fewer patients in the cangrelor group than in the clopidogrel group (3.8 vs. 4.7 %) (odds ratio 0.80; 95 % CI 0.67–0.97; P = 0.02). Similarly, the incidence of MI using the SCAI definition for periprocedural MI was lower in patients receiving cangrelor compared with those receiving clopidogrel (1.0 vs. 1.5 %) (odds ratio 0.65; 95 % CI 0.46–0.92; P = 0.01). In addition, cangrelor also reduced MIs defined by several other definitions, including peak creatine phosphokinase myocardial band (CK-MB) that was ≥10 times the upper limit normal (ULN), CK-MB ≥10 times ULN with ischemic symptoms or electrocardiogram (ECG) changes, and those with ischemic symptoms or ECG changes alone. These findings further validate the beneficial effect of cangrelor in reducing ischemic events in patients undergoing PCI.

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