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• W4285806817 abstract "HomeCirculation: Cardiovascular InterventionsVol. 15, No. 7Letter by Zaghloul et al Regarding Article, “Ischemic Events Occur Early in Patients Undergoing Percutaneous Coronary Intervention and Are Reduced With Cangrelor: Findings From CHAMPION PHOENIX” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Zaghloul et al Regarding Article, “Ischemic Events Occur Early in Patients Undergoing Percutaneous Coronary Intervention and Are Reduced With Cangrelor: Findings From CHAMPION PHOENIX” Sheref Zaghloul, MBBS, Nishil Patel, MBChB and Mahmood Ahmad, MBBS Sheref ZaghloulSheref Zaghloul https://orcid.org/0000-0002-2539-8698 Department of Cardiology, Royal Free Hospital, London, United Kingdom (S.Z., M.A.). Search for more papers by this author , Nishil PatelNishil Patel https://orcid.org/0000-0001-7106-881X North Middlesex University Hospital, London, United Kingdom (N.P.). Search for more papers by this author and Mahmood AhmadMahmood Ahmad Department of Cardiology, Royal Free Hospital, London, United Kingdom (S.Z., M.A.). Search for more papers by this author Originally published19 Jul 2022https://doi.org/10.1161/CIRCINTERVENTIONS.122.012098Circulation: Cardiovascular Interventions. 2022;15To the Editor:We read with interest the recent article by Cavender et al,1 which demonstrated the results of the CHAMPION PHOENIX trial (A Clinical Trial Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who Require Percutaneous Coronary Intervention), which was a double-blind, placebo-controlled trial that randomized patients undergoing percutaneous coronary intervention (PCI) to cangrelor or clopidogrel. In the first 2 hours, after randomization, cangrelor significantly decreased the primary composite end point compared with clopidogrel (4.1% versus 5.4%). Similar findings were seen for the composite end point of death. These findings provide evidence that support the importance of potent platelet inhibition during PCI. However, discrepancies exist between this analysis and the analysis by Lu et al,2 which had a total of 5031 participants with type 2 diabetes (between the years 2006 and 2012). In patients with type 2 diabetes, cangrelor was comparable to clopidogrel in terms of efficacy at 48 hours following PCI. However, it was associated with significantly higher mild GUSTO criteria (Global Utilization of Streptokinase and tPA for Occluded Arteries) bleeding and major and minor ACUITY criteria (Acute Catheterization and Urgent Intervention Triage Strategy) bleeding. In addition, Bhatt et al3 randomly assigned 5362 patients who had not been treated with clopidogrel to receive either cangrelor or placebo at the time of PCI, followed by 600 mg of clopidogrel. The primary end point was a composite of death, myocardial infarction, or ischemia-driven revascularization at 48 hours. They concluded that the use of periprocedural cangrelor during PCI was not superior to placebo in reducing the primary end point. The prespecified secondary end points of stent thrombosis and death were lower in the cangrelor group, with no significant increase in the rate of transfusion.Yong et al4 compared the efficacy and safety of cangrelor in single vessel versus multivessel PCI, concluding that with both single vessel-PCI and multivessel-PCI, cangrelor was associated with similar relative risk reductions in ischemic complications compared with clopidogrel. This highlights the expanding repertoire of options available for use in complex PCI.In conclusion, despite these findings from Cavender et al, further studies will be required to show the superiority of cangrelor over clopidogrel, especially with regards to the primary end point and bleeding risk in high-risk patients.Article InformationDisclosures None.FootnotesThis manuscript was sent to Frederick G. Welt, Senior Guest Editor, for review by expert referees, editorial decision, and final disposition.https://www.ahajournals.org/journal/circinterventionsReferences1. Cavender MA, Harrington RA, Stone GW, Steg PG, Gibson CM, Hamm CW, Price MJ, Lopes RD, Leonardi S, Deliargyris EN, et al; CHAMPION PHOENIX Investigators. Ischemic events occur early in patients undergoing percutaneous coronary intervention and are reduced with cangrelor: findings from CHAMPION PHOENIX.Circ Cardiovasc Interv. 2022; 15:e010390. doi: 10.1161/CIRCINTERVENTIONS.120.010390LinkGoogle Scholar2. Lu H, Guan W, Zhou Y, Tang Z, Bao H. Cangrelor or clopidogrel in patients with type 2 diabetes mellitus undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials.Diabetes Ther. 2019; 10:937–950. doi: 10.1007/s13300-019-0593-7CrossrefMedlineGoogle Scholar3. Bhatt DL, Lincoff AM, Gibson CM, Stone GW, McNulty S, Montalescot G, Kleiman NS, Goodman SG, White HD, Mahaffey KW, et al; CHAMPION PLATFORM Investigators. Intravenous platelet blockade with cangrelor during PCI.N Engl J Med. 2009; 361:2330–2341. doi: 10.1056/NEJMoa0908629CrossrefMedlineGoogle Scholar4. Yong CM, Sundaram V, Abnousi F, Olivier CB, Yang J, Stone GW, Steg PG, Michael GC, Hamm CW, Price MJ, et al. The efficacy and safety of cangrelor in single vessel vs multivessel percutaneous coronary intervention: insights from CHAMPION PHOENIX.Clin Cardiol. 2019; 42:797–805. doi: 10.1002/clc.23221CrossrefGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails July 2022Vol 15, Issue 7 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/CIRCINTERVENTIONS.122.012098PMID: 35861799 Originally publishedJuly 19, 2022 PDF download Advertisement SubjectsCatheter-Based Coronary and Valvular InterventionsPercutaneous Coronary InterventionPharmacologyRevascularization" @default.
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