The efficacy and safety of cangrelor in single vessel vs multivessel percutaneous coronary intervention: Insights from CHAMPION PHOENIX
The efficacy and safety of cangrelor in single vessel vs multivessel percutaneous coronary intervention: Insights from CHAMPION PHOENIX
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坎格雷洛在单支血管与多支经皮冠状动脉介入治疗中的疗效和安全性：CHAMPION PHOENIX 的见解
DOI：
10.1002/clc.23221
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发表时间：
2019
影响因子：
2.7
通讯作者：
Mahaffey KW
中科院分区：
文献类型：
--
作者：
Yong CM;Sundaram V;Abnousi F;Olivier CB;Yang J;Stone GW;Steg PG;Gibson CM;Hamm CW;Price MJ;Deliargyris E;Prats J;White HD;Harrington RA;Bhatt DL;Mahaffey KW
研究背景静脉注射快速起效的P2Y12抑制剂Cangrelor可降低经皮冠状动脉介入治疗期间缺血事件的发生率，但不会显著增加严重出血的发生率。然而，在接受单支或多支冠状动脉介入治疗(SV)或多支冠状动脉介入治疗(MV)的患者中，康瑞尔与氯吡格雷的有效性和安全性的比较仍未被探讨。方法我们研究了改良的意向治疗人群，这些患者来自菲尼克斯冠军试验，他们被随机分为康瑞尔或氯吡格雷。我们使用Logistic回归和倾向评分匹配来评估康瑞尔和氯吡格雷在48 小时对主要疗效结果(死亡、心肌梗死、缺血导致的血管重建或支架血栓形成)的影响。结果在10854例患者中，9204例(85%)接受了SV-PCI术，1650例(15%)接受了MV- 。调整后，在接受SV-PCI或MV-PCI的患者中，康瑞尔的主要疗效结果与氯吡格雷相似(4.5%比5.2%；优势比[OR]0.81[0.66-0.98])或MV-PCI(6.1%比9.8%，OR 0.59[0.41-0.85]；品脱0.14)。在倾向评分匹配后也观察到类似的结果(SV-PCI：5.5%vs 5.9%，OR 0.93[0.74~1.18]；MV-PCI：6.2%vs 8.9%，OR 0.67[0.44~1.01]；Pint 0.17)。与氯吡格雷相比，康瑞尔的治疗效果没有异质性的证据。结论在接受SV-或MV-PCI的患者中，与氯吡格雷相比，康瑞尔在缺血性并发症的相对风险降低方面与氯吡格雷相似，而大出血的风险没有增加，这突显了复杂PCI的选择范围的扩大。
BackgroundThe intravenous, rapidly acting P2Y12 inhibitor cangrelor reduces the rate of ischemic events during PCI with no significant increase in severe bleeding. However, the efficacy and safety of cangrelor compared with clopidogrel in patients treated with single vessel (SV)‐percutaneous coronary intervention (PCI) or multivessel (MV)‐PCI remains unexplored.MethodsWe studied the modified intention‐to‐treat population of patients from the CHAMPION PHOENIX trial who were randomized to either cangrelor or clopidogrel. We used logistic regression and propensity score matching to evaluate the effect of cangrelor compared with clopidogrel on the primary efficacy outcome (composite of death, myocardial infarction, ischemia‐driven revascularization, or stent thrombosis) at 48 hours. The safety outcome was moderate or severe Global Utilization of Streptokinase and tPA for Occluded Arteries bleeding at 48 hours.HypothesisCangrelor is as efficacious and safe as clopidogrel in both SV and MV PCI.ResultsAmong 10 854 patients, 9204 (85%) underwent SV‐ and 1650 (15%) MV‐PCI. After adjustment, cangrelor was associated with similar reductions vs clopidogrel in the primary efficacy outcome in patients undergoing SV‐PCI (4.5% vs 5.2%; odds ratio [OR] 0.81 [0.66‐0.98]) or MV‐PCI (6.1% vs 9.8%, OR 0.59 [0.41‐0.85]; Pint 0.14). Similar results were observed after propensity score matching (SV‐PCI: 5.5% vs 5.9%, OR 0.93 [0.74‐1.18]; MV‐PCI: 6.2% vs 8.9%, OR 0.67 [0.44‐1.01]; Pint 0.17). There was no evidence of heterogeneity in the treatment effect of cangrelor compared with clopidogrel for the safety outcome.ConclusionsIn patients undergoing SV‐ or MV‐PCI, cangrelor was associated with similar relative risk reductions in ischemic complications and no increased risk of significant bleeding compared with clopidogrel, which highlights the expanding repertoire of options for use in complex PCI.
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影响因子：
4.8
作者：
Leonardi, Sergio;Mahaffey, Kenneth W.;Bhatt, Deepak L.
通讯作者：
Bhatt, Deepak L.
影响因子：
4.8
作者：
Brener, Sorin J.;Milford-Beland, Sarah;Brindis, Ralph G.
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Brindis, Ralph G.
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2.8
作者：
Brener, SJ;Murphy, SA;Cannon, CP
通讯作者：
Cannon, CP
影响因子：
5.7
作者：
Casey, C;Faxon, DP
通讯作者：
Faxon, DP
影响因子：
1.6
作者：
Mokadam, Nahush A.;Melford, Ryland E., Jr.;Aldea, Gabriel S.
通讯作者：
Aldea, Gabriel S.