Why the study?
PAD increases ischemic risk following PCI, and more aggressive antiplatelet therapy may mitigate this risk, prompting evaluation of cangrelor efficacy in this population.
Does cangrelor reduce the composite of death, myocardial infarction, or ischemia-driven revascularization in patients with peripheral artery disease undergoing percutaneous coronary intervention compared to clopidogrel or placebo?
Does cangrelor reduce the composite of death, myocardial infarction, or ischemia-driven revascularization in patients with peripheral artery disease undergoing percutaneous coronary intervention compared to clopidogrel or placebo?
Cangrelor reduces ischemic events without increasing severe bleeding in patients with peripheral artery disease undergoing PCI, consistent with its benefits in the broader PCI population.
Cangrelor reduces ischemic events in PAD patients undergoing PCI without excess severe bleeding; extends CHAMPION findings to this high-risk subgroup.
Background: Peripheral artery disease (PAD) is associated with an increased risk of ischemic events following percutaneous coronary intervention (PCI). More aggressive antiplatelet therapy may mitigate this risk. The present study evaluates the efficacy of cangrelor in patients with PAD undergoing PCI. Methods and results: This is a pooled analysis from the CHAMPION PCI, CHAMPION PLATFORM, AND CHAMPION PHOENIX trials, evaluating cangrelor versus either clopidogrel or placebo in PCI patients. The occurrence of the primary endpoint of death, myocardial infarction, or ischemia-driven revascularization (IDR) was assessed in patients with and without PAD. GUSTO severe bleeding at 48 h was also evaluated. There were 1720 (7%) patients with PAD and 22,802 (93%) without PAD. After adjustment for differences in baseline variables, PAD patients, compared with those without PAD, experienced increased odds of the primary endpoint (OR [95% CI] = 1.27 [0.91, 1.77], P = 0.16) and GUSTO severe bleeding (OR [95% CI] = 3.24 [1.28, 8.21], P = 0.01). In PAD patients, the primary endpoint was 4.7% with cangrelor vs. 7.2% with clopidogrel (OR [95% CI] = 0.64 [0.42,0.96]); in patients without PAD the primary endpoint was 3.5% with cangrelor vs. 4.2% with clopidogrel (OR [95% CI] = 0.83 [0.72,0.95]), P-interaction 0.23. Among patients with or without PAD, there was no significant difference in the rate of GUSTO severe bleeding with cangrelor compared with control, P-interaction 0.86. Conclusions: In a pooled analysis of the CHAMPION studies, PAD was associated with increased rates of ischemic and bleeding complications. Cangrelor reduced the odds of ischemic events, without increasing GUSTO severe bleeding. Clinical trial registration: clinicaltrials.gov identifiers: CHAMPION PCI (NCT00305162), CHAMPION PLATFORM(NCT00385138), CHAMPION PHOENIX (NCT01156571).
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Gutierrez et al. (2021) studied this question.
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