Cangrelor compared with clopidogrel in patients with prior myocardial infarction – Insights from the CHAMPION trials

Background Patients who have had a prior myocardial infarction (MI) are at increased risk for adverse outcomes after subsequent percutaneous coronary intervention (PCI). Objective The objective of this study is to examine the efficacy and safety of cangrelor, a potent intravenous P2Y₁₂ inhibitor, in patients with prior MI. Methods Pooled data from the CHAMPION trials were examined. Prior MI was defined as a history of MI, excluding MI events at baseline. The primary endpoint was a composite of death, MI, ischemia-driven revascularization, or stent thrombosis at 48-h post-randomization. The primary safety endpoint was GUSTO-defined severe bleeding at 48 h. Results Out of 24,691 patients, 5699 (23%) had a prior MI. The primary endpoint was higher in patients with vs. without prior MI (4.9% vs. 4.0%, p = 0.002). The primary endpoint was 4.2% with cangrelor vs. 5.7% with clopidogrel (absolute risk reduction = 1.5%; OR 0.72 [95%CI 0.57–0.92]) in patients with prior MI and 3.7% with cangrelor vs. 4.3% with clopidogrel (absolute risk reduction = 0.6%; OR 0.85 [95%CI 0.74–0.99]) in patients without prior MI (P-interaction = 0.25). The rate of GUSTO-defined severe bleeding was 0.1% with cangrelor vs. 0.1% with clopidogrel (OR 1.39 [95%CI 0.31–6.24]) in patients with prior MI, and 0.2% with cangrelor vs. 0.2% with clopidogrel (OR 1.18 [95%CI 0.65–2.14]) in patients without prior MI (P-interaction = 0.84). Conclusion In the CHAMPION trials, patients with prior MI had higher rates of ischemic outcomes within 48 h after PCI. Cangrelor reduced ischemic events with no significant increase in GUSTO-defined severe bleeding in patients with or without prior MI.