CHAMPION (CHAMPION–PCI and

CHAMPION–PLATFORM)

CHAMPION (CHAMPION–PCI and CHAMPION–PLATFORM)

• Population:

ACS patients scheduled for PCI

• Treatments:

CHAMPION–PCI: 8716 patients randomized to cangrelor infusion (within 30

minutes before PCI and continued for two hours) followed by clopidogrel 600 mg, or

clopidogrel 600 mg (within 30 minutes before PCI) followed by placebo tablets

CHAMPION–PLATFORM: 5362 patients randomized to cangrelor infusion (within

30 minutes before PCI and continued for two hours) followed by clopidogrel 600 mg

at the end of the infusion, or placebo infusion followed by clopidogrel 600 mg given

after PCI

• Primary outcome:

All-cause death/MI/ischemia-driven revascularization at 48 hours

D Bhatt (Brigham and Women’s Hospital, Boston, MA) American Heart Association 2009 Scientific Sessions

Outcome

Cangrelor

(n=3889), %

Clopidogrel

(n=3865), %

Odds ratio

(95% CI)

p

Death/MI/ischemia-driven revascularization

(primary end point)

7.5 7.1 1.05 (0.88–1.24) 0.59

Major bleeding, ACUITY criteria 3.6 2.9 1.26 (0.99–1.60) 0.06

Major bleeding, TIMI criteria 0.4 0.3 1.36 (0.68–2.17) 0.39

Severe or life-threatening bleeding, GUSTO criteria 0.2 0.3 0.91 (0.39–2.14) 0.82

Major results at 48 hours

• Cangrelor was not superior to clopidogrel with respect to the primary end point

CHAMPION–PCI: Results

Outcome

Cangrelor

(n=2654), %

Placebo

(n=2641), %

Odds ratio

(95% CI)

p

Death/MI/ischemia-driven revascularization

(primary end point)

7.0 8.0 0.87 (0.71–1.07) 0.17

Death 0.2 0.7 0.33 (0.13–0.83) 0.02

Stent thrombosis 0.2 0.6 0.31 (0.11–0.85) 0.02

Major bleeding, ACUITY criteria 5.5 3.5 1.61 (1.23–2.10) <0.001

Major bleeding, TIMI criteria 0.2 0.3 0.44 (0.14–1.44) 0.17

Severe or life-threatening bleeding, GUSTO criteria 0.3 0.2 1.50 (0.53–4.21) 0.45

Major results at 48 hours

• No significant difference in the primary end point between cangrelor and placebo

groups

• Stent thrombosis and death (two prespecified end points) significantly reduced

in the cangrelor group

CHAMPION–PLATFORM: Results

CHAMPION: Commentary*

*All comments from Cangrelor in CHAMPION: What went wrong?

(http://www.theheart.org/article/1023633.do)

"We used a relatively liberal definition for periprocedural MI of three times upper

limit of normal for CKMB rises . . . In hindsight, it would probably have been better

to use a stricter definition like five times the upper limit of normal or even eight

times."

- Dr Robert Harrington

(lead investigator , CHAMPION–PCI)

"The CHAMPION investigators have overestimated the relevance of some of their

observations . . . The most likely explanation for these findings is the play of

chance."

- Dr Sanjay Kaul

"There is a great interest in cangrelor, as it is the first IV P2Y12 antagonist, which

we would welcome for acute use in the cath lab."

- Dr David Faxon

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