Consistent Reduction in Periprocedural Myocardial Infarction With Cangrelor as Assessed by Multiple Definitions
Consistent Reduction in Periprocedural Myocardial Infarction With Cangrelor as Assessed by Multiple Definitions
复制标题
通过多种定义评估坎格瑞洛持续减少围手术期心肌梗塞
作者：
M. Cavender;Deepak L. Bhatt;G. Stone;H. White;P. Steg;C. Gibson;C. Hamm;M. Price;S. Leonardi;J. Prats;E. Deliargyris;K. Mahaffey;R. Harrington
背景：坎格瑞洛是一种静脉注射 P2Y12 抑制剂，被批准用于减少未经 P2Y12 抑制剂预处理而接受经皮冠状动脉介入治疗的患者的围手术期缺血事件。方法：在 CHAMPION PHOENIX 试验（坎格瑞洛与标准疗法以实现血小板抑制的最佳管理）中，共有 11-145 名患者被随机分配接受坎格瑞洛或氯吡格雷治疗。我们使用不同的定义探讨了坎格雷洛对心肌梗死（MI）的影响，并对试验的主要终点进行了敏感性分析。结果：共有 462 名接受经皮冠状动脉介入治疗的患者 (4.2%) 患有第二个通用定义所定义的 MI。大多数 MI（n=433，93.7%）为 4a 型。坎格雷洛治疗降低了 48 小时 MI 的发生率（3.8% 对比 4.7%；比值比 [OR]，0.80；95% 置信区间 [CI]，0.67–0.97；P=0.02）。当冠状动脉造影和干预协会对围手术期心肌梗死的定义应用于潜在的缺血事件时，总心肌梗死较少（n=134）；然而，坎格雷洛对 MI 的影响仍然显着（OR，0.65；95% CI，0.46-0.92；P=0.01）。在评估坎格瑞洛对肌酐激酶-MB峰值≥正常上限10倍（OR，0.64；95% CI，0.45-0.91）的心肌梗死以及肌酐激酶-MB峰值≥正常上限10倍、缺血症状或心电图变化（OR，0.63；95% CI， 0.48–0.84）。由任何这些定义定义的 MI 都与 30 天死亡风险增加相关。坎格雷洛治疗可减少死亡、心肌梗死（冠状动脉造影和介入学会定义）、缺血驱动的血运重建或学术研究联盟确定的支架内血栓形成等复合终点（1.4% vs 2.1%；OR，0.69；95% CI，0.51-0.92）。结论：无论定义如何，接受经皮冠状动脉介入治疗的患者的心肌梗死仍然与当今时代的死亡风险增加相关。无论定义如何，坎格瑞洛与氯吡格雷相比都能显着降低 MI。临床试验注册：URL：http://clinicaltrials.gov。唯一标识符：NCT01156571。
BACKGROUND: Cangrelor is an intravenous P2Y12 inhibitor approved to reduce periprocedural ischemic events in patients undergoing percutaneous coronary intervention not pretreated with a P2Y12 inhibitor. METHODS: A total of 11 145 patients were randomized to cangrelor or clopidogrel in the CHAMPION PHOENIX trial (Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition). We explored the effects of cangrelor on myocardial infarction (MI) using different definitions and performed sensitivity analyses on the primary end point of the trial. RESULTS: A total of 462 patients (4.2%) undergoing percutaneous coronary intervention had an MI as defined by the second universal definition. The majority of these MIs (n=433, 93.7%) were type 4a. Treatment with cangrelor reduced the incidence of MI at 48 hours (3.8% versus 4.7%; odds ratio [OR], 0.80; 95% confidence interval [CI], 0.67–0.97; P=0.02). When the Society of Coronary Angiography and Intervention definition of periprocedural MI was applied to potential ischemic events, there were fewer total MIs (n=134); however, the effects of cangrelor on MI remained significant (OR, 0.65; 95% CI, 0.46–0.92; P=0.01). Similar effects were seen in the evaluation of the effects of cangrelor on MIs with peak creatinine kinase-MB ≥10 times the upper limit of normal (OR, 0.64; 95% CI, 0.45–0.91) and those with peak creatinine kinase-MB ≥10 times the upper limit of normal, ischemic symptoms, or ECG changes (OR, 0.63; 95% CI, 0.48–0.84). MIs defined by any of these definitions were associated with increased risk of death at 30 days. Treatment with cangrelor reduced the composite end point of death, MI (Society of Coronary Angiography and Intervention definition), ischemia-driven revascularization, or Academic Research Consortium definite stent thrombosis (1.4% versus 2.1%; OR, 0.69; 95% CI, 0.51–0.92). CONCLUSIONS: MI in patients undergoing percutaneous coronary intervention, regardless of definition, remains associated with increased risk of death in the current era. Cangrelor compared with clopidogrel significantly reduces MI regardless of the definition. CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov. Unique identifier: NCT01156571.
考虑冠状动脉血运重建后临床相关心肌梗塞的新定义：心血管血管造影和干预协会（SCAI）的专家共识文件（SCAI）。
影响因子：
24
作者：
Moussa, Issam D.;Klein, Lloyd W.;Shah, Binita;Mehran, Roxana;Mack, Michael J.;Brilakis, Emmanouil S.;Reilly, John P.;Zoghbi, Gilbert;Holper, Elizabeth;Stone, Gregg W.
通讯作者：
Stone, Gregg W.