Background: Exploratory analysis from CHAMPION-AF trials showed that cangrelor has significantly lower bleeding rates with comparable ischemic events when compared to bailout glycoprotein IIb/IIIa inhibitors (GPI) in patients undergoing percutaneous coronary intervention (PCI). However, to date, there are no real-world studies comparing both adjunctive antiplatelet therapies. Thus, we performed this study to evaluate the safety and effectiveness of cangrelor during PCI.
Methods: This is a retrospective, single-center study from the PCI registry at MedStar Cardiovascular Research Network. We identified patients who underwent PCI at our institution who received either cangrelor or bailout GPI as an adjunctive antiplatelet therapy during PCI. Patients who were already on GPI prior to PCI and who received both cangrelor and GPI were excluded from the analysis. Baseline demographics were extracted. Clinical ischemic and bleeding events during the hospital stay and at 30 days were compared between both groups.
Results: A total of 2072 patients received adjunctive antiplatelet therapy during PCI (cangrelor [n=478] and GPI [n=1594]). The mean age of the study group was 61±12 years. The majority of patients (66%) presented with acute coronary syndrome. Compared to those who received GPI, patients who received cangrelor were older, had a higher percentage of acute coronary syndrome and lower baseline hematocrit (Hct). Procedural success was achieved in 94% of patients, with no difference between groups. Major bleeding events, defined as a composite of hematoma >4 cm, Hct drop >15 and gastrointestinal bleeding were significantly lower in the cangrelor group (1.7% vs. 5.1%, p=0.001). Vascular complication rates and in-hospital length of stay were significantly higher in the GPI group. In-hospital ischemic events such as myocardial infarction, all-cause mortality, and stent thrombosis rates did not differ between either group. At 30 days, significantly lower rates of myocardial infarction and target-vessel revascularization were noted in the cangrelor group.
Conclusion: Balancing ischemic and bleeding risks with adjunctive antiplatelet drugs is of prime importance during PCI. Our real-world analysis confirms the previous exploratory analysis from the CHAMPION-AF trials and shows that cangrelor is safe and effective when compared to bailout GPI during PCI.
Cardiovascular Revascularization Medicine, Volume 28, Supplement, July 2021, Page S24
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