Platelet inhibition with cangrelor in patients undergoing PCI

Robert A. Harrington, Gregg W. Stone, Steven McNulty, Harvey D. White, A. Michael Lincoff, C. Michael Gibson, Charles V. Pollack, Gilles Montalescot, Kenneth W. Mahaffey, Neal S. Kleiman, Shaun G. Goodman, Maged Amine, Dominick J. Angiolillo, Richard C. Becker, Derek P. Chew, William J. French, Franz Leisch, Keyur H. Parikh, Simona Skerjanec, Deepak L. Bhatt

Research output: Contribution to journalArticle

468 Citations (Scopus)

Abstract

BACKGROUND: Cangrelor, a nonthienopyridine adenosine triphosphate analogue, is an intravenous blocker of the adenosine diphosphate receptor P2Y 12. This agent might have a role in the treatment of patients who require rapid, predictable, and profound but reversible platelet inhibition. METHODS: We performed a large-scale international trial comparing cangrelor with 600 mg of oral clopidogrel administered before percutaneous coronary intervention (PCI) in patients with acute coronary syndromes. The primary efficacy end point was a composite of death from any cause, myocardial infarction, or ischemia-driven revascularization at 48 hours. RESULTS: We enrolled 8877 patients, and 8716 underwent PCI. At 48 hours, cangrelor was not superior to clopidogrel with respect to the primary composite end point, which occurred in 7.5% of patients in the cangrelor group and 7.1% of patients in the clopidogrel group (odds ratio, 1.05; 95% confidence interval [CI], 0.88 to 1.24; P = 0.59). Likewise, cangrelor was not superior at 30 days. The rate of major bleeding (according to Acute Catheterization and Urgent Intervention Triage Strategy criteria) was higher with cangrelor, a difference that approached statistical significance (3.6% vs. 2.9%; odds ratio, 1.26; 95% CI, 0.99 to 1.60; P = 0.06), but this was not the case with major bleeding (according to the Thrombolysis in Myocardial Infarction criteria) or severe or life-threatening bleeding (according to Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries criteria). A secondary exploratory end point of death from any cause, Q-wave myocardial infarction, or ischemia-driven revascularization showed a trend toward a reduction with cangrelor, but it was not significant (0.6% vs. 0.9%; odds ratio, 0.67; 95% CI, 0.39 to 1.14; P = 0.14). CONCLUSIONS: Cangrelor, when administered intravenously 30 minutes before PCI and continued for 2 hours after PCI, was not superior to an oral loading dose of 600 mg of clo pidogrel, administered 30 minutes before PCI, in reducing the composite end point of death from any cause, myocardial infarction, or ischemia-driven revascularization at 48 hours. (ClinicalTrials.gov number, NCT00305162.)

LanguageEnglish
Pages2318-2329
Number of pages12
JournalNew England Journal of Medicine
Volume361
Issue number24
DOIs
Publication statusPublished - 10 Dec 2009

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Harrington, R. A., Stone, G. W., McNulty, S., White, H. D., Lincoff, A. M., Gibson, C. M., ... Bhatt, D. L. (2009). Platelet inhibition with cangrelor in patients undergoing PCI. New England Journal of Medicine, 361(24), 2318-2329. https://doi.org/10.1056/NEJMoa0908628