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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe final results of the Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition [CHAMPION] PCI [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00305162\u0026amp;atom=%2Fspmdc%2F9%2F5%2F12.atom\u0022\u003ENCT00305162\u003C\/a\u003E] and CHAMPION PLATFORM [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00385138\u0026amp;atom=%2Fspmdc%2F9%2F5%2F12.atom\u0022\u003ENCT00385138\u003C\/a\u003E] trials showed no clinical benefit with cangrelor for the primary composite outcome of death, myocardial infarction, and ischemic-driven revascularization in patients who were undergoing percutaneous coronary intervention.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe final results of the Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition (CHAMPION) PCI (\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00305162\u0026amp;atom=%2Fspmdc%2F9%2F5%2F12.atom\u0022\u003ENCT00305162\u003C\/a\u003E) and CHAMPION PLATFORM (\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00385138\u0026amp;atom=%2Fspmdc%2F9%2F5%2F12.atom\u0022\u003ENCT00385138\u003C\/a\u003E) trials showed no clinical benefit with cangrelor for the primary composite outcome of death, myocardial infarction (MI), and ischemic-driven revascularization (IDR) in patients who were undergoing percutaneous coronary intervention (PCI). Both studies were halted early in May of this year for futility, based on recommendations from an independent Interim Analysis Review Committee (IARC).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIn CHAMPION PCI, presented by Robert A. Harrington, MD, Duke Clinical Research Institute, Durham, NC, 8877 patients (median age 62 years; 26% women) with stable angina or ACS (unstable angina (UA), ST-segment elevation or non-ST-segment-elevation myocardial infarction [STEMI; NSTEMI]) were randomly assigned in a double-blind double-dummy design to receive either intravenous (IV) cangrelor (30-\u03bcg\/kg bolus 30 minutes before PCI and 4-\u03bcg\/kg\/min infusion continuing for 2 hours; n=4367) followed by 600 mg of placebo at the completion of the infusion or 600 mg of clopidogrel with IV placebo bolus and infusion (n=4355).\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe median age was 62 years, 27% were female, 31% had diabetes, and 25% had prior MI. The presenting diagnoses were as follows: stable angina 15%, UA 25%, NSTEMI 49%, and STEMI 11%. The median time from hospitalization was 6.3 hours (range 2.6 to 27 hours), and the median duration of infusion was 2.1 hours (interquartile range [IQR] 2.0 to 2.2 hours). The primary endpoint (a composite of death from any cause, MI, and ischemia-driven revascularization or IDR) at 48 hours occurred in 7.5% of subjects in the cangrelor group versus 7.1% of subjects in the clopidogrel-only group (OR 1.05; 95% CI, 0.88, to 1.24; p=0.59). This was a modified intention-to-treat population that included patients who underwent randomization (excluding the STEMI cohort), received at least one dose of a study drug, and underwent the index PCI. Patients with STEMI were excluded from the primary efficacy analysis due to challenges in measuring reinfarction in the early hours of STEMI. There was no difference in stent thrombosis between the groups (0.2% cangrelor vs 0.3% clopidogrel; p=0.34).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAdverse events were similar in the two groups overall (26.4% cangrelor vs 25.7% clopidogrel), with the exception of dyspnea, which occurred in significantly more subjects who received cangrelor (1.0% vs 0.4% in the clopidogrel group; p=0.001). Major bleeding was similar between those who were randomized to cangrelor versus clopidogrel (ACUITY Major 3.6% vs 2.9%; p=0.06; GUSTO severe or life-threatening 0.2% versus 0.3%; p=0.82; TIMI Major 0.4% vs 0.3%; p=0.39). Only ACUITY minor bleeding (17.6% vs 15.2; p=0.003) and GUSTO mild bleeding (19.6% vs 16.9% with; p=0.001) were significantly higher in the cangrelor group. There were no differences in other bleeding categories and no increase in the need for blood transfusion.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EIn the CHAMPION PLATFORM trial, presented by Deepak L. Bhatt, MD, Brigham and Women\u0027s Hospital, Boston, MA, the primary endpoint and eligibility criteria were the same as in the PCI study except for the exclusion of patients with STEMI. Patients (median age 63 years; 29% female, 32% diabetics, 25% history of MI) were randomly assigned to receive cangrelor (30-\u03bcg\/kg bolus and 4-\u03bcg\/kg\/min infusion for the duration of PCI; n=2654) or placebo (n=2641). All patients received clopidogrel 600 mg after PCI. Only 5% had stable angina, while 35% had UA and 60% had NSTEMI. The median time from admission to PCI was 7.9 hours (IQR 3.3 to 24.1), and median duration of infusion was 2.1 hours (IQR 2.0 to 2.3).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe primary endpoint, assessed in a modified intention-to-treat cohort that consisted of all patients who underwent randomization, received at least one dose of a study drug, and underwent the index PCI, occurred in 7.0% of patients in the cangrelor group versus 8.0% of patients in the clopidogrel-only group (OR, 0.87; 95% CI, 0.71 to 1.07; p=0.17). At 48 hours, the rate of stent thrombosis was reduced with cangrelor, from 0.6% to 0.2% (OR, 0.31; 95% CI, 0.11 to 0.85; p=0.02), and all-cause mortality was reduced with cangrelor, from 0.7% to 0.2% (OR, 0.33; 95% CI, 0.13 to 0.83; p=0.02).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe rates of ACUITY minor and GUSTO mild bleeding were higher in the cangrelor group (ACUITY 12.0% vs 9.3%; p=0.001; GUSTO 16.0% vs 11.7%; p\u0026lt;0.001), primarily driven by an increase in groin hematomas. There was no increase in the need for transfusion, even among high-risk groups. Dyspnea was more common in the cangrelor group (1.4%) compared with clopidogrel only (0.5%; p=0.002). Other adverse events were similar between the two groups.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EWhile these two trials of this IV-reversible ADP antagonist were stopped early due to futility (low likelihood to show a statistically significant difference in the primary endpoint), there were some intriguing findings. Cangrelor was associated with a similar to slightly higher bleeding risk compared with clopidogrel 600 mg pre-PCI in CHAMPION PCI but offered a much quicker onset and offset of action. Compared with clopidogrel that was given post-PCI (as in CHAMPION PLATFORM), cangrelor was associated with a reduction in mortality and in stent thrombosis but caused more groin hematomas. The short time from hospital admission to PCI and definition of MI may have limited the ability to detect a reduction in procedure-related MI in both trials. Specific populations may benefit from this agent, and additional carefully designed investigations are warranted.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section ref-list\u0022 id=\u0022ref-list-1\u0022\u003E\u003Ch2 class=\u0022\u0022\u003EAdditional Reading\u003C\/h2\u003E\u003Col class=\u0022cit-list ref-use-labels\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label ref-label-empty\u0022\u003E\u003C\/span\u003E\n            \u003Cdiv class=\u0022cit ref-cit ref-journal no-rev-xref\u0022 id=\u0022cit-9.5.12.1\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EHarrington\u003C\/span\u003E  \u003Cspan class=\u0022cit-name-given-names\u0022\u003ERA\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-etal\u0022\u003Eet al\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EPlatelet Inhibition with Cangrelor in Patients Undergoing PCI\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EN Engl J Med\u003C\/abbr\u003E \n               \u003Cspan class=\u0022cit-pub-date\u0022\u003E2009\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E361\u003C\/span\u003E. Published online 15 November 2009.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label ref-label-empty\u0022\u003E\u003C\/span\u003E\n            \u003Cdiv class=\u0022cit ref-cit ref-journal no-rev-xref\u0022 id=\u0022cit-9.5.12.2\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EBhatt\u003C\/span\u003E  \u003Cspan class=\u0022cit-name-given-names\u0022\u003EDL\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-etal\u0022\u003Eet al\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EIntravenous Platelet Blockade with Cangrelor during PCI\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EN Engl J Med\u003C\/abbr\u003E \n               \u003Cspan class=\u0022cit-pub-date\u0022\u003E2009\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E361\u003C\/span\u003E. Published online 15 November 2009.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label ref-label-empty\u0022\u003E\u003C\/span\u003E\n            \u003Cdiv class=\u0022cit ref-cit ref-journal no-rev-xref\u0022 id=\u0022cit-9.5.12.3\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EKastrati\u003C\/span\u003E  \u003Cspan class=\u0022cit-name-given-names\u0022\u003EA\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ENdrepepa\u003C\/span\u003E  \u003Cspan class=\u0022cit-name-given-names\u0022\u003EG. Cangrelor\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E \u2014 \u003Cspan class=\u0022cit-article-title\u0022\u003EA Champion Lost in Translation\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EN Engl J Med.\u003C\/abbr\u003E Published online 15 November 2009.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003C\/li\u003E\u003C\/ol\u003E\u003C\/div\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/9\/5\/12.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmhvd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}