Consistent Reduction in Periprocedural Myocardial Infarction With Cangrelor as Assessed by Multiple Definitions: Findings From CHAMPION PHOENIX (Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition)
Consistent Reduction in Periprocedural Myocardial Infarction With Cangrelor as Assessed by Multiple Definitions: Findings From CHAMPION PHOENIX (Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition)
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DOI：
10.1161/circulationaha.115.020829
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发表时间：
2016-09-06
期刊：
影响因子：
37.8
通讯作者：
Harrington, Robert A.
中科院分区：
文献类型：
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作者：
Cavender, Matthew A.;Bhatt, Deepak L.;Harrington, Robert A.
背景：canrelor是一种静脉注射P2Y（12）抑制剂，被批准用于减少未经P2Y（12）抑制剂预处理的经皮冠状动脉介入治疗患者的术中缺血事件。方法：在CHAMPION PHOENIX试验中，共有11145名患者被随机分配到康瑞洛或氯吡格雷组（康瑞洛与标准治疗实现血小板抑制的最佳管理）。我们使用不同的定义探讨了康格洛对心肌梗死（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例（4.2%）接受经皮冠状动脉介入治疗的患者出现了第二种通用定义的心肌梗死。这些MIs以4a型为主（n=433, 93.7%）。使用angrelor治疗可降低48小时心肌梗死的发生率（3.8% vs . 4.7%；优势比[OR]， 0.80； 95%可信区间[CI]， 0.67-0.97； P=0.02）。当冠状动脉造影与介入学会对术中心肌梗死的定义应用于潜在的缺血性事件时，心肌梗死总数减少（n=134）；然而，康格洛对心肌梗死的影响仍然显著（OR, 0.65; 95% CI, 0.46-0.92； P=0.01）。在评估康格瑞洛对肌酸酐激酶- mb峰值为正常上限10倍的心肌梗死患者（OR, 0.64; 95% CI, 0.45-0.91）和肌酸酐激酶- mb峰值为正常、缺血症状或心电图变化上限10倍的心肌梗死患者（OR, 0.63; 95% CI, 0.48-0.84）的影响时，也可以看到类似的效果。这些定义中任何一种定义的MIs与30天死亡风险增加有关。使用angrelor治疗降低了死亡、MI（冠状动脉造影和干预协会定义）、缺血驱动的血运重建术或学术研究协会确定的支架血栓形成的复合终点（1.4%对2.1%;or, 0.69; 95% CI, 0.51-0.92）。结论：在当前时代，接受经皮冠状动脉介入治疗的患者心肌梗死，无论其定义如何，仍与死亡风险增加相关。无论心肌梗死的定义如何，与氯吡格雷相比，康格瑞可显著降低心肌梗死。临床试验注册：网址：http://clinicaltrials.gov。唯一标识符：NCT01156571。
BACKGROUND: Cangrelor is an intravenous P2Y(12) inhibitor approved to reduce periprocedural ischemic events in patients undergoing percutaneous coronary intervention not pretreated with a P2Y(12) inhibitor.METHODS: A total of 11145 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.