• Retrospective Study: Cangrelor Reduces Ischemic Events Without Increasing Bleeding vs. GPI in PCI

    Cangrelor reduced ischemic events without increasing bleeding as compared to glycoprotein IIb/IIIa inhibitors (GPIs) in patients undergoing percutaneous coronary intervention (PCI), according to a single-center study presented Friday at CRT 2021 Virtual.

    Antiplatelet medications are used to block platelet generation, with the aim of reducing ischemic events after PCI. Cangrelor, a non-thienopyridine intravenous adenosine triphosphate analogue, blocks adenosine diphosphate P2Y12 receptors. In contrast to other antiplatelet drugs, cangrelor acts quickly, and platelet function also returns rapidly, after the medication is dispensed.

    GPIs have been shown to reduce major adverse cardiovascular events in comparison to heparin alone in patients undergoing PCI for acute coronary syndromes but at the expense of an increased risk of major bleeding. A 2017 exploratory analysis from the CHAMPION trials showed no difference in ischemic events between PCI patients who received cangrelor and those who received GPI, but major bleeding was significantly lower in the cangrelor arm.

    Charan Yerasi, MD, of MedStar Washington Hospital Center, Washington, D.C., presented a single-center retrospective analysis of 2072 patients who received either cangrelor or GPI as adjunctive antiplatelet therapy during PCI.

    The patients’ mean age was 61±12 years, 69% were men, 55% were white, and 34% were Black. Two-thirds presented with acute coronary syndromes, and most (79%) had Canadian Cardiovascular Society class III or IV angina. More than three-fourths of the patients received GPI (77%; n=1594), while 23% (n=478) received cangrelor.

    The GPI group had a higher percentage of white patients (57.7%) than the cangrelor group (46.7%; p<0.001), while the cangrelor group had a higher percentage of Black patients (38.5%) than the GPI group (33.1%; p=0.03). While ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI) was the predominant presentation in both groups, the percentage of STEMI/NSTEMI patients was even more pronounced in the cangrelor group (75.4% vs. 63.8% in the GPI group; p<0.001).

    In-hospital ischemic events were similar between the two groups,  including all-cause mortality (cangrelor 3.6% vs. GPI 3.9%; p=0.70), cardiac death (3.1% vs. 3.4%; p=0.79); and cerebrovascular accident (0.9% vs. 0.4%; p=0.23). However, the length of stay (LOS) and number of days in the intensive care unit (ICU) were both significantly lower in the cangrelor group (LOS: cangrelor 3.5±3.9 days vs. GPI 4.3±5.4 days, p<0.001; ICU: 1.1±1.8 days vs. 1.9±3.6 days, p<0.001).

    And in-hospital bleeding and vascular events were significantly lower in the cangrelor arm, including major bleeding (1.7% vs. 5.1%, p=0.001).

    A regression analysis showed that patients who received cangrelor had a significantly lower major bleeding event rate than those who received GPI (odds ratio, 0.23; 95% confidence interval: 0.09-0.59).

    “In this real-world analysis, cangrelor was effective in reducing ischemic events without increasing bleeding events when compared to GPI,” Yerasi said. “Future randomized studies are needed in acute coronary syndromes to compare GPI with short infusion to cangrelor.”

    CRT 2021 Virtual takes place Fridays and Saturdays through April 24. On-demand content from the meeting is available here

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