• Philippe Gabriel Steg, Deepak L Bhatt, Christian W Hamm, Gregg W Stone, C Michael Gibson, Kenneth W Mahaffey, Sergio Leonardi, Tiepu Liu, Simona Skerjanec, Jonathan R Day, Robert S Iwaoka, Thomas D Stuckey, Harinder S Gogia, Luis Gruberg, William J French, Harvey D White, Robert A Harrington, and CHAMPION Investigators.
• Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France; Département Hospitalo-Universitaire FIRE, Hôpital Bichat, AP-HP, INSERM U-698, Paris, France. Electronic address: gabriel.steg@bch.aphp.fr.
• Lancet. 2013 Dec 14; 382 (9909): 198119921981-92.

BackgroundCangrelor is a potent, rapid-acting, reversible intravenous platelet inhibitor that was tested for percutaneous coronary intervention (PCI) in three large, double-blind, randomised trials. We did a pooled analysis of data from three trials that assessed the effectiveness of cangrelor against either clopidogrel or placebo in PCI.MethodsThis prespecified, pooled analysis of patient-level data from three trials (CHAMPION-PCI, CHAMPION-PLATFORM, and CHAMPION-PHOENIX) compared cangrelor with control (clopidogrel or placebo) for prevention of thrombotic complications during and after PCI. Trial participants were patients undergoing PCI for ST-elevation myocardial infarction (11.6%), non-ST-elevation acute coronary syndromes (57.4%), and stable coronary artery disease (31.0%). Efficacy was assessed in the modified intention-to-treat population of 24,910 patients, with a prespecified primary efficacy composite of death, myocardial infarction, ischaemia-driven revascularisation, or stent thrombosis at 48 h. The primary safety outcome was non-coronary artery bypass graft-related GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) severe or life-threatening bleeding at 48 h.FindingsCangrelor reduced the odds of the primary outcome by 19% (3.8% for cangrelor vs 4.7% for control; odds ratio [OR] 0.81, 95% CI 0.71-0.91, p=0.0007), and stent thrombosis by 41% (0.5% vs 0.8%, OR 0.59, 95% CI 0.43-0.80, p=0.0008). Cangrelor reduced the odds of the secondary triple composite (all-cause death, myocardial infarction, or ischaemia-driven revascularisation at 48 h) by 19% (3.6% vs 4.4%, OR 0.81, 95% CI 0.71-0.92, p=0.0014). Efficacy outcomes were consistent across the trials and main patient subsets. These benefits were maintained at 30 days. There was no difference in the primary safety outcome (0.2% in both groups), in GUSTO moderate bleeding (0.6% vs 0.4%), or in transfusion (0.7% vs 0.6%), but cangrelor increased GUSTO mild bleeding (16.8% vs 13.0%, p<0.0001).InterpretationCompared with control (clopidogrel or placebo), cangrelor reduced PCI periprocedural thrombotic complications, at the expense of increased bleeding.FundingThe Medicines Company.Copyright © 2013 Elsevier Ltd. All rights reserved.

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