Key result
Cangrelor shows no benefit over clopidogrel for major events at 48 hours during PCI.
Why the study?
Does cangrelor reduce the composite of death, MI, and ischaemia-driven revascularisation at 48 hours compared to clopidogrel in patients undergoing PCI?
Meta-Analysis (n=25,107)
Does cangrelor reduce the composite of death, MI, and ischaemia-driven revascularisation at 48 hours compared to clopidogrel in patients undergoing PCI?
Effect estimate: OR 0.94 (95% CI 0.77-1.14)
p-value: p=0.51
Cangrelor did not significantly reduce the primary composite endpoint of death, MI, and ischemia-driven revascularization at 48 hours compared to clopidogrel, but it was associated with a lower risk of stent thrombosis, ischemia-driven revascularization, and Q-wave MI without increasing severe bleeding.
Cangrelor is not superior to clopidogrel for the primary ischemic composite at 48 hours during PCI; confirms lack of benefit on this endpoint in meta-analysis.
AIMS: Cangrelor is a new antiplatelet agent that has been used in percutaneous coronary intervention (PCI) with mixed results. We aimed to review the evidence on the efficacy of cangrelor in comparison to clopidogrel in reducing ischaemic endpoints at 48 hours in patients undergoing PCI in large randomised trials. METHODS AND RESULTS: In three large clinical trials involving 25,107 participants, the risk of the primary composite efficacy endpoint of death, MI and ischaemia-driven revascularisation at 48 hours, (pooled OR 0.94; 95% CI: 0.77-1.14, p=0.51, I2=68%), death from all cause (pooled OR 0.72, 95% CI: 0.36-1.43, p=0.34, I2=52%), myocardial infarction (pooled OR 0.94, 95% CI: 0.77-1.14, p=0.51, I2=68%) was not significantly different between cangrelor and clopidogrel. Likewise, severe or life-threatening bleeding was similar between cangrelor and clopidogrel (pooled OR 1.21, 95% CI: 0.70-2.12, p=0.50, I2=0%). The risk of stent thrombosis (pooled OR 0.59, 95% CI: 0.43-0.81, p=0.001, I2=0%), Q-wave myocardial infarction (pooled OR 0.53, 95% CI: 0.30-0.92, p=0.02, I2=0%) and ischaemia-driven revascularisation (pooled OR 0.71, 95% CI: 0.52-0.98, p=0.04, I2=0%) was lower in the cangrelor group. CONCLUSIONS: Based on this meta-analysis, we did not find any difference in the risk of the primary composite efficacy endpoint of all-cause death, ischaemia-driven revascularisation, and myocardial infarction at 48hours between cangrelor and clopidogrel use. Given that cangrelor was associated with a lower risk of stent thrombosis, ischaemia-driven revascularisation and Q-wave myocardial infarction compared to clopidogrel, cangrelor can be considered as a suitable alternative during PCI.
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Pandit et al. (2014) conducted a meta-analysis in percutaneous coronary intervention (n=25,107). Cangrelor vs. Clopidogrel was evaluated on composite efficacy endpoint of death, MI and ischaemia-driven revascularisation at 48 hours (OR 0.94, 95% CI 0.77-1.14, p=0.51). Cangrelor did not significantly reduce the composite of death, MI, and ischaemia-driven revascularisation at 48 hours compared to clopidogrel during PCI (OR 0.94; 95% CI 0.77-1.14; p=0.51).
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