NEW YORK (Reuters Health) – Early ischemic events are reduced in patients undergoing percutaneous coronary intervention for acute coronary syndrome when they’re treated with cangrelor rather than clopidogrel for platelet inhibition, researchers report in the February issue of the Americal Journal of Cardiology.

“There was no increase in major bleeding, but there was an increase in clinically significant and minor bleeding,” note Dr. Harvey White, at Auckland City Hospital, in New Zealand, and colleagues.

The findings come from an analysis of two large trials comparing the parenteral P2Y-12 inhibitor cangrelor with clopidogrel in a total of 13,049 ACS patients undergoing PCI.

Cangrelor was not shown to be superior to clopidogrel in reducing the 48-hour primary endpoint, driven mainly by the occurrence of MI, the authors explain. “However, MI is difficult to ascertain post-PCI,” they continue.

They therefore conducted the current study, a pre-specified analysis of pooled data from the two trials, using the universal definition of MI associated with PCI: i.e., “elevation of biomarkers >3 times the 99th percentile upper limit of normal.”

On that basis, the primary endpoint of death, MI, or ischemia-driven revascularization (including stent thrombosis) at 48 hours, was lower with cangrelor (3.1%) than with clopidogrel (3.8%), which translated to an odds ratio of 0.82 (p=0.037), the team reports.

The rate of major bleeding was 0.3% in both groups, but clinically significant bleeding was increased with cangrelor versus clopidogrel (4.3% vs 3.1%; p=0.0002), as was minor bleeding (15.5% vs 13.0%; p<0.0001), Dr. White and colleagues found.

They conclude, “In the current study, augmenting platelet inhibition with cangrelor was associated with an 18% reduction in early ischemic events and reduced rates of stent thrombosis. These relative benefits are comparable to those seen with prasugrel and ticagrelor.”

However, they add, “Further appropriately designed trials, able to accurately ascertain ischemic end points, particularly the occurrence of periprocedural MI, are required to confirm the potential role of cangrelor in managing patients with ACS undergoing PCI.”

SOURCE:

Reduced immediate ischemic events with cangrelor in PCI: A pooled analysis of the CHAMPION trials using the universal definition of myocardial infarction

Am Heart J 2012;163:182-190.e4.