Cangrelor reduces the risk of ischemic complications in patients with single-vessel and multi-vessel disease undergoing percutaneous coronary intervention: Insights from the CHAMPION PHOENIX trial

Freddy Abnousi, Vandana Sundaram, Celina M. Yong, Jayne Prats, Efthymios N. Deliargyris, Gregg W. Stone, Christian W. Hamm, Philippe Gabriel Steg, Charles Michael Gibson, Harvey D. White, Matthew J. Price, Philippe Généreux, Manisha Desai, Lingyao Yang, Victoria Y. Ding, Robert A. Harrington, Deepak L. Bhatt, Kenneth W. Mahaffey

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective To examine the safety and efficacy of cangrelor in patients with single-vessel disease (SVD) and multi-vessel disease (MVD). Background Cangrelor, an intravenous, rapidly acting P2Y12 inhibitor, is superior to clopidogrel in reducing ischemic events among patients receiving percutaneous coronary intervention (PCI). Methods We studied a modified intention to treat population of patients with SVD and MVD from the CHAMPION PHOENIX trial. The primary efficacy outcome was the composite of death, myocardial infarction (MI), ischemia-driven revascularization (IDR), and stent thrombosis (ST) at 48 hours. The key safety outcome was non–coronary artery bypass grafting GUSTO severe bleeding at 48 hours. Results Among 10,921 patients, 5,220 (48%) had SVD and 5,701 (52%) had MVD. MVD patients were older and more often had diabetes, hyperlipidemia, hypertension, prior stroke, and prior MI. After adjustment, MVD patients had similar rates of 48-hour death/MI/IDR/ST (6.3% vs 4.2%, adjusted odds ratio [OR] 1.6 [95% CI 0.42-6.06]) and GUSTO severe bleeding (0.1% vs 0.2%, P = .67) compared with SVD patients. Consistent with overall trial findings, cangrelor use reduced ischemic complications in patients with both SVD (3.9% vs 4.5%; OR 0.86, 95% CI 0.65-1.12) and MVD (5.5% vs 7.2%; OR 0.74, 95% CI 0.6-0.92, P-interaction = .43). GUSTO severe bleeding outcomes were not significantly increased with cangrelor or clopidogrel in either SVD or MVD patients. Conclusion In the CHAMPION PHOENIX trial, MVD and SVD patients had similar ischemic outcomes at 48 hours and 30 days. Cangrelor consistently reduced ischemic complications in both SVD and MVD patients without a significant increase in GUSTO severe bleeding. Clinical perspectives What's known? Cangrelor is a novel, intravenous, potent, and rapidly acting P2Y12 inhibitor that has been demonstrated to reduce the rate of ischemic events at 48 hours in patients who received PCI compared with clopidogrel. What's new? In contrast to prior studies, we found that in this modern cohort, patients with SVD and MVD had a similar risk of ischemic complications and GUSTO severe bleeding after PCI. We also found that cangrelor consistently reduced ischemic complications in both SVD and MVD patients without a significant increase in GUSTO severe bleeding. What's next? To assess the impact of single vessel PCI versus multivessel PCI in patients with SVD and MVD.

Original languageEnglish (US)
Pages (from-to)147-155
Number of pages9
JournalAmerican Heart Journal
Volume188
DOIs
StatePublished - Jun 1 2017
Externally publishedYes

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Percutaneous Coronary Intervention
clopidogrel
Hemorrhage
cangrelor
Odds Ratio
Myocardial Infarction
Stents
Myocardial Ischemia
Thrombosis
Safety
Social Adjustment

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Abnousi, Freddy ; Sundaram, Vandana ; Yong, Celina M. ; Prats, Jayne ; Deliargyris, Efthymios N. ; Stone, Gregg W. ; Hamm, Christian W. ; Steg, Philippe Gabriel ; Gibson, Charles Michael ; White, Harvey D. ; Price, Matthew J. ; Généreux, Philippe ; Desai, Manisha ; Yang, Lingyao ; Ding, Victoria Y. ; Harrington, Robert A. ; Bhatt, Deepak L. ; Mahaffey, Kenneth W. / Cangrelor reduces the risk of ischemic complications in patients with single-vessel and multi-vessel disease undergoing percutaneous coronary intervention : Insights from the CHAMPION PHOENIX trial. In: American Heart Journal. 2017 ; Vol. 188. pp. 147-155.
@article{602f6c0dccb04b2387a9a1a78e35b00c,
title = "Cangrelor reduces the risk of ischemic complications in patients with single-vessel and multi-vessel disease undergoing percutaneous coronary intervention: Insights from the CHAMPION PHOENIX trial",
abstract = "Objective To examine the safety and efficacy of cangrelor in patients with single-vessel disease (SVD) and multi-vessel disease (MVD). Background Cangrelor, an intravenous, rapidly acting P2Y12 inhibitor, is superior to clopidogrel in reducing ischemic events among patients receiving percutaneous coronary intervention (PCI). Methods We studied a modified intention to treat population of patients with SVD and MVD from the CHAMPION PHOENIX trial. The primary efficacy outcome was the composite of death, myocardial infarction (MI), ischemia-driven revascularization (IDR), and stent thrombosis (ST) at 48 hours. The key safety outcome was non–coronary artery bypass grafting GUSTO severe bleeding at 48 hours. Results Among 10,921 patients, 5,220 (48{\%}) had SVD and 5,701 (52{\%}) had MVD. MVD patients were older and more often had diabetes, hyperlipidemia, hypertension, prior stroke, and prior MI. After adjustment, MVD patients had similar rates of 48-hour death/MI/IDR/ST (6.3{\%} vs 4.2{\%}, adjusted odds ratio [OR] 1.6 [95{\%} CI 0.42-6.06]) and GUSTO severe bleeding (0.1{\%} vs 0.2{\%}, P = .67) compared with SVD patients. Consistent with overall trial findings, cangrelor use reduced ischemic complications in patients with both SVD (3.9{\%} vs 4.5{\%}; OR 0.86, 95{\%} CI 0.65-1.12) and MVD (5.5{\%} vs 7.2{\%}; OR 0.74, 95{\%} CI 0.6-0.92, P-interaction = .43). GUSTO severe bleeding outcomes were not significantly increased with cangrelor or clopidogrel in either SVD or MVD patients. Conclusion In the CHAMPION PHOENIX trial, MVD and SVD patients had similar ischemic outcomes at 48 hours and 30 days. Cangrelor consistently reduced ischemic complications in both SVD and MVD patients without a significant increase in GUSTO severe bleeding. Clinical perspectives What's known? Cangrelor is a novel, intravenous, potent, and rapidly acting P2Y12 inhibitor that has been demonstrated to reduce the rate of ischemic events at 48 hours in patients who received PCI compared with clopidogrel. What's new? In contrast to prior studies, we found that in this modern cohort, patients with SVD and MVD had a similar risk of ischemic complications and GUSTO severe bleeding after PCI. We also found that cangrelor consistently reduced ischemic complications in both SVD and MVD patients without a significant increase in GUSTO severe bleeding. What's next? To assess the impact of single vessel PCI versus multivessel PCI in patients with SVD and MVD.",
author = "Freddy Abnousi and Vandana Sundaram and Yong, {Celina M.} and Jayne Prats and Deliargyris, {Efthymios N.} and Stone, {Gregg W.} and Hamm, {Christian W.} and Steg, {Philippe Gabriel} and Gibson, {Charles Michael} and White, {Harvey D.} and Price, {Matthew J.} and Philippe G{\'e}n{\'e}reux and Manisha Desai and Lingyao Yang and Ding, {Victoria Y.} and Harrington, {Robert A.} and Bhatt, {Deepak L.} and Mahaffey, {Kenneth W.}",
year = "2017",
month = "6",
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doi = "10.1016/j.ahj.2017.02.031",
language = "English (US)",
volume = "188",
pages = "147--155",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",

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Abnousi, F, Sundaram, V, Yong, CM, Prats, J, Deliargyris, EN, Stone, GW, Hamm, CW, Steg, PG, Gibson, CM, White, HD, Price, MJ, Généreux, P, Desai, M, Yang, L, Ding, VY, Harrington, RA, Bhatt, DL & Mahaffey, KW 2017, 'Cangrelor reduces the risk of ischemic complications in patients with single-vessel and multi-vessel disease undergoing percutaneous coronary intervention: Insights from the CHAMPION PHOENIX trial', American Heart Journal, vol. 188, pp. 147-155. https://doi.org/10.1016/j.ahj.2017.02.031

Cangrelor reduces the risk of ischemic complications in patients with single-vessel and multi-vessel disease undergoing percutaneous coronary intervention : Insights from the CHAMPION PHOENIX trial. / Abnousi, Freddy; Sundaram, Vandana; Yong, Celina M.; Prats, Jayne; Deliargyris, Efthymios N.; Stone, Gregg W.; Hamm, Christian W.; Steg, Philippe Gabriel; Gibson, Charles Michael; White, Harvey D.; Price, Matthew J.; Généreux, Philippe; Desai, Manisha; Yang, Lingyao; Ding, Victoria Y.; Harrington, Robert A.; Bhatt, Deepak L.; Mahaffey, Kenneth W.

In: American Heart Journal, Vol. 188, 01.06.2017, p. 147-155.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cangrelor reduces the risk of ischemic complications in patients with single-vessel and multi-vessel disease undergoing percutaneous coronary intervention

T2 - Insights from the CHAMPION PHOENIX trial

AU - Abnousi, Freddy

AU - Sundaram, Vandana

AU - Yong, Celina M.

AU - Prats, Jayne

AU - Deliargyris, Efthymios N.

AU - Stone, Gregg W.

AU - Hamm, Christian W.

AU - Steg, Philippe Gabriel

AU - Gibson, Charles Michael

AU - White, Harvey D.

AU - Price, Matthew J.

AU - Généreux, Philippe

AU - Desai, Manisha

AU - Yang, Lingyao

AU - Ding, Victoria Y.

AU - Harrington, Robert A.

AU - Bhatt, Deepak L.

AU - Mahaffey, Kenneth W.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Objective To examine the safety and efficacy of cangrelor in patients with single-vessel disease (SVD) and multi-vessel disease (MVD). Background Cangrelor, an intravenous, rapidly acting P2Y12 inhibitor, is superior to clopidogrel in reducing ischemic events among patients receiving percutaneous coronary intervention (PCI). Methods We studied a modified intention to treat population of patients with SVD and MVD from the CHAMPION PHOENIX trial. The primary efficacy outcome was the composite of death, myocardial infarction (MI), ischemia-driven revascularization (IDR), and stent thrombosis (ST) at 48 hours. The key safety outcome was non–coronary artery bypass grafting GUSTO severe bleeding at 48 hours. Results Among 10,921 patients, 5,220 (48%) had SVD and 5,701 (52%) had MVD. MVD patients were older and more often had diabetes, hyperlipidemia, hypertension, prior stroke, and prior MI. After adjustment, MVD patients had similar rates of 48-hour death/MI/IDR/ST (6.3% vs 4.2%, adjusted odds ratio [OR] 1.6 [95% CI 0.42-6.06]) and GUSTO severe bleeding (0.1% vs 0.2%, P = .67) compared with SVD patients. Consistent with overall trial findings, cangrelor use reduced ischemic complications in patients with both SVD (3.9% vs 4.5%; OR 0.86, 95% CI 0.65-1.12) and MVD (5.5% vs 7.2%; OR 0.74, 95% CI 0.6-0.92, P-interaction = .43). GUSTO severe bleeding outcomes were not significantly increased with cangrelor or clopidogrel in either SVD or MVD patients. Conclusion In the CHAMPION PHOENIX trial, MVD and SVD patients had similar ischemic outcomes at 48 hours and 30 days. Cangrelor consistently reduced ischemic complications in both SVD and MVD patients without a significant increase in GUSTO severe bleeding. Clinical perspectives What's known? Cangrelor is a novel, intravenous, potent, and rapidly acting P2Y12 inhibitor that has been demonstrated to reduce the rate of ischemic events at 48 hours in patients who received PCI compared with clopidogrel. What's new? In contrast to prior studies, we found that in this modern cohort, patients with SVD and MVD had a similar risk of ischemic complications and GUSTO severe bleeding after PCI. We also found that cangrelor consistently reduced ischemic complications in both SVD and MVD patients without a significant increase in GUSTO severe bleeding. What's next? To assess the impact of single vessel PCI versus multivessel PCI in patients with SVD and MVD.

AB - Objective To examine the safety and efficacy of cangrelor in patients with single-vessel disease (SVD) and multi-vessel disease (MVD). Background Cangrelor, an intravenous, rapidly acting P2Y12 inhibitor, is superior to clopidogrel in reducing ischemic events among patients receiving percutaneous coronary intervention (PCI). Methods We studied a modified intention to treat population of patients with SVD and MVD from the CHAMPION PHOENIX trial. The primary efficacy outcome was the composite of death, myocardial infarction (MI), ischemia-driven revascularization (IDR), and stent thrombosis (ST) at 48 hours. The key safety outcome was non–coronary artery bypass grafting GUSTO severe bleeding at 48 hours. Results Among 10,921 patients, 5,220 (48%) had SVD and 5,701 (52%) had MVD. MVD patients were older and more often had diabetes, hyperlipidemia, hypertension, prior stroke, and prior MI. After adjustment, MVD patients had similar rates of 48-hour death/MI/IDR/ST (6.3% vs 4.2%, adjusted odds ratio [OR] 1.6 [95% CI 0.42-6.06]) and GUSTO severe bleeding (0.1% vs 0.2%, P = .67) compared with SVD patients. Consistent with overall trial findings, cangrelor use reduced ischemic complications in patients with both SVD (3.9% vs 4.5%; OR 0.86, 95% CI 0.65-1.12) and MVD (5.5% vs 7.2%; OR 0.74, 95% CI 0.6-0.92, P-interaction = .43). GUSTO severe bleeding outcomes were not significantly increased with cangrelor or clopidogrel in either SVD or MVD patients. Conclusion In the CHAMPION PHOENIX trial, MVD and SVD patients had similar ischemic outcomes at 48 hours and 30 days. Cangrelor consistently reduced ischemic complications in both SVD and MVD patients without a significant increase in GUSTO severe bleeding. Clinical perspectives What's known? Cangrelor is a novel, intravenous, potent, and rapidly acting P2Y12 inhibitor that has been demonstrated to reduce the rate of ischemic events at 48 hours in patients who received PCI compared with clopidogrel. What's new? In contrast to prior studies, we found that in this modern cohort, patients with SVD and MVD had a similar risk of ischemic complications and GUSTO severe bleeding after PCI. We also found that cangrelor consistently reduced ischemic complications in both SVD and MVD patients without a significant increase in GUSTO severe bleeding. What's next? To assess the impact of single vessel PCI versus multivessel PCI in patients with SVD and MVD.

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