Christian Hamm

A Classification of Unstable Angina Revisited

Unstable angina is a critical phase of coronary heart disease with widely variable symptoms and prognosis. A decade ago, a classification of unstable angina based on clinical symptoms was introduced. This system was then validated by prospective clinical studies to correlate with the prognosis and was linked to angiographic and histological findings. It has been used to categorize patients in many large clinical trials. In recent years, the pathophysiological roles of platelet activation and inflammation in unstable angina have been elucidated. Subsequently, improved markers of myocardial injury, acute-phase proteins, and hemostatic markers that may be associated with clinical outcomes have been identified. Particularly, cardiac-specific troponin T and troponin I have been shown to represent the best predictors of early risk in patients with angina at rest. Accordingly, it is suggested that the original classification be extended by subclassifying one large group of unstable angina patients, ie, those with angina at rest within the past 48 hours (class IIIB), into troponin-positive (T(pos)) and troponin-negative (T(neg)) patients. The 30-days risk for death and myocardial infarction is considered to be up to 20% in class IIIB-T(pos) but <2% in class IIIB-T(neg) patients. Initial results suggest that troponins may function as surrogate markers for thrombus formation and can effectively guide therapy with glycoprotein IIb/IIIa antagonists or low-molecular-weight heparins. These observations provide additional impetus for adding the measurement of these markers to the clinical classification and represent a novel concept of treating these high-risk patients.

Incidence, Predictors, and Outcomes of Acquired Thrombocytopenia After Percutaneous Coronary Intervention: A Pooled, Patient-Level Analysis of the CHAMPION Trials (Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition)

Background— The influence of cangrelor on the incidence and outcomes of post-percutaneous coronary intervention (PCI) thrombocytopenia is not defined. We aimed to explore the incidence, predictors, and clinical impact of thrombocytopenia after PCI in cangrelor-treated patients. Methods and Results— This was a pooled, patient-level analysis of the CHAMPION trials (Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition), which compared cangrelor with clopidogrel for prevention of thrombotic complications during and after PCI. Acquired thrombocytopenia was defined as either a drop in platelet count to <100 000 after PCI or a drop of >50% between baseline and a follow-up. The main efficacy outcome was major adverse cardiac events. The primary safety outcome was noncoronary artery bypass grafting–related Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries–defined severe bleeding at 48 hours. Patients (23 783) were enrolled, and 3009 (12.7%) received a GPI (glycoprotein IIb/IIIa inhibitor). Acquired thrombocytopenia occurred in 200 patients (0.8%). The adjusted rate of major adverse cardiovascular events at 48 hours was significantly higher in patients who developed thrombocytopenia compared with those who did not (odds ratio, 3.00; 95% confidence interval, 1.89–4.69; P<0.001), as was major bleeding (odds ratio, 14.71; 95% confidence interval, 5.96–36.30; P<0.001). GPI use was the strongest independent predictor of acquired thrombocytopenia (odds ratio, 2.93; 95% confidence interval, 2.15–3.97; P<0.0001). There was no difference in the rate of acquired thrombocytopenia in patients randomized to cangrelor or clopidogrel. Conclusions— Acquired thrombocytopenia after PCI is strongly associated with substantial early morbidity and mortality, as well as major bleeding. GPI use is a significant predictor of thrombocytopenia. Cangrelor is not associated with acquired thrombocytopenia, and its clinical efficacy and safety is consistent irrespective of thrombocytopenia occurrence. Clinical Trial Registration— URL: https://www.clinicaltrials.gov. Unique identifiers: NCT00305162, NCT00385138, and NCT01156571.

THE EFFICACY, SAFETY, AND NET CLINICAL BENEFIT OF CANGRELOR IN WOMEN UNDERGOING ELECTIVE OR URGENT PCI: INSIGHTS FROM THE CHAMPION-PHOENIX TRIAL

Cangrelor is an intravenous ADP receptor antagonist that leads to potent and reversible inhibition of platelet aggregation. The relative efficacy and safety of some antiplatelet drugs in women have been disputed. We therefore evaluated the efficacy and safety of cangrelor in women undergoing PCI.

THE EFFICACY AND SAFETY OF CANGRELOR FOR PATIENTS UNDERGOING SINGLE VESSEL VERSUS MULTI VESSEL PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM THE CHAMPION PHOENIX TRIAL

The intravenous, rapidly acting P2Y12 inhibitor cangrelor reduces the rate of ischemic events during percutaneous coronary intervention (PCI) with no significant increase in severe bleeding. This study aimed to evaluate the efficacy and safety of cangrelor in patients treated with single vessel (SV

THE EFFICACY AND SAFETY OF CANGRELOR WITH AND WITHOUT GLYCOPROTEIN IIB/IIIA INHIBITORS IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: A POOLED ANALYSIS OF THE CHAMPION TRIALS

Cangrelor, an intravenous, reversible P2Y12 antagonist, was recently approved for use in patients undergoing percutaneous coronary intervention (PCI) in the US. We evaluated the efficacy and safety of cangrelor compared with clopidogrel in the subgroup who received glycoprotein IIb/IIIa inhibitors

IMPACT OF CANGRELOR OVERDOSING ON BLEEDING COMPLICATIONS IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM THE CHAMPION TRIALS

Overdosing of parenteral antithrombotic drugs can increase the risk of bleeding. Cangrelor is a potent intravenous platelet P2Y12 receptor with rapid onset and offset of action. Compared with clopidogrel,cangrelor reduces periprocedural thrombotic complications in patients undergoing percutaneous