Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand.
Am Heart J. 2012 Feb;163(2):182-90.e4. doi: 10.1016/j.ahj.2011.11.001.
There is a clinical need for an intravenous P2Y(12) inhibitor in patients with acute coronary syndromes (ACS) for patients who are unable to take oral medications or might benefit from a rapidly reversible compound. As the time from admission to percutaneous coronary intervention (PCI) shortens, establishing the benefit of novel therapies impacting ischemic events is increasingly challenging. Cangrelor, an intravenous potent rapidly acting P2Y(12) inhibitor, bolus 30 μg/Kg plus infusion of 4 μg/Kg/min, was compared to a 600-mg loading dose of clopidogrel either before or early after PCI in patients with ACS undergoing PCI in The CHAMPION (Cangrelor versus standard tHerapy to Achieve optimal Management of Platelet InhibitiON) PLATFORM and PCI studies.
As both CHAMPION studies used similar inclusion/exclusion criteria and death, myocardial infarction, or ischemia-driven revascularization (including stent thrombosis) at 48 hours as their primary end points, the studies were pooled. The clinical events committee adjudicated myocardial infarction. The universal definition was used to define myocardial infarction.
A total of 13 049 patients were included. Cangrelor had no effect on the primary end point with the original MI definition (P = .646). With the use of the universal definition, the primary end point was decreased with cangrelor (odds ratio 0.82, 95% confidence interval 0.68-0.99, P = .037). Stent thrombosis was reduced from 0.4% to 0.2% (odds ratio 0.44, 95% confidence interval 0.22-0.87, P = .018). Thrombolysis in Myocardial Infarction major bleeding and transfusions were not increased with cangrelor.
With the use of the universal definition of myocardial infarction, cangrelor was associated with a significant reduction in early ischemic events when compared with clopidogrel in patients with non-ST-elevation ACS undergoing PCI.
对于急性冠脉综合征（ACS）患者，由于无法口服药物或可能受益于快速逆转化合物，因此临床需要静脉内 P2Y(12)抑制剂。随着从入院到经皮冠状动脉介入治疗（PCI）的时间缩短，评估新型治疗方法对缺血性事件影响的获益变得越来越具有挑战性。坎格瑞洛是一种静脉内强效、快速作用的 P2Y(12)抑制剂，静脉推注 30μg/Kg 加输注 4μg/Kg/min，与 ACS 患者 PCI 前或 PCI 后早期的氯吡格雷 600mg 负荷剂量进行比较，这些患者在 The CHAMPION（坎格瑞洛与标准 tHerapy 以实现最佳血小板抑制）PLATFORM 和 PCI 研究中接受 PCI。
由于两项 CHAMPION 研究均使用了相似的纳入/排除标准以及 48 小时时的死亡、心肌梗死或缺血驱动的血运重建（包括支架血栓形成）作为主要终点，因此对这些研究进行了汇总。临床事件委员会裁定心肌梗死。使用通用定义来定义心肌梗死。
共纳入 13049 例患者。坎格瑞洛对原始 MI 定义的主要终点没有影响（P =.646）。使用通用定义时，坎格瑞洛降低了主要终点（比值比 0.82，95%置信区间 0.68-0.99，P =.037）。支架血栓形成从 0.4%降至 0.2%（比值比 0.44，95%置信区间 0.22-0.87，P =.018）。与坎格瑞洛相比，血栓溶解心肌梗死大出血和输血没有增加。
与氯吡格雷相比，使用通用心肌梗死定义时，坎格瑞洛可显著降低非 ST 段抬高型 ACS 患者 PCI 后的早期缺血性事件。
