Cost implications of intraprocedural thrombotic events and bleeding in percutaneous coronary intervention: Results from the CHAMPION PHOENIX ECONOMICS Study

Tamez, Hector; Généreux, Philip; Yeh, Robert W.; Amin, Amit P.; Fan, Wei; White, Harvey D.; Kirtane, Ajay J.; Stone, Gregg W.; Gibson, C. Michael; Harrington, Robert A.; Bhatt, Deepak L.; Pinto, Duane S.; Investigators, Champion Phoenix

doi:10.1002/ccd.27638

Cited by 6 publications

(4 citation statements)

References 19 publications

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“…While our study did not evaluate the cost implications of a prolonged cangrelor infusion, sub-analysis of the CHAMPION PHOENIX study revealed that the increased cost of cangrelor may be offset by a reduction in intra-procedural thrombotic events during PCI resulting in lower major adverse cardiac events, mortality, procedural and hospitalization costs, and shorter hospital stays (6). Rates of major and minor bleeding were similar between cangrelor and clopidogrel in this study, but needs further study in the ischemic stroke population who are prone to intracranial hemorrhage.…”

Section: Discussionmentioning

confidence: 89%

“…Given the predictable pharmacokinetics in patients with a wide variety of underlying co-morbidities, it provides an important solution for acute neurointerventions. Randomized clinical trials in interventional cardiology have found that intravenous cangrelor may be a useful and cost-effective substitute for currently used oral antiplatelets (4)(5)(6). Given the differences in patient characteristics, clinical outcomes, and treatment considerations from cardiac patients, we sought to determine the safety and efficacy of using low dose cangrelor infusions in patients with acute ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

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Safety of Low Dose Intravenous Cangrelor in Acute Ischemic Stroke: A Case Series

et al. 2021

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Background: Neurointerventional procedures in acute ischemic stroke often require immediate antiplatelet therapy in the cases of acute stenting and occasionally re-occluding vessels. Intravenous cangrelor is a P2Y12 receptor antagonist with short onset and quick offset. The study objective was to evaluate the safety and efficacy of intravenous cangrelor in patients with acute ischemic stroke requiring urgent antiplatelet effect.Methods: Patients who received intravenous cangrelor intra-procedurally during acute ischemic stroke treatment were identified from a prospectively collected database. Cangrelor was administered as a bolus of 15 mcg/kg, followed by an infusion rate of 2 mcg/kg/min. A historical control group consisting of anterior circulation tandem occlusions was used to compare to patients with similar lesions who received intravenous cangrelor. Outcomes of interest included in-stent thrombosis, thromboembolic complications, intracranial hemorrhage, and functional outcomes at 90 days.Results: Twelve patients received intravenous cangrelor for acute ischemic stroke between October 2018 and April 2020 at a comprehensive stroke center. Eleven patients had intra or extracranial stenting performed, which included two posterior circulation lesions. No cases of symptomatic intracranial hemorrhage were reported. At 90 day follow-up, two patients had died and 10 had a good functional outcome. Patients with anterior circulation tandem occlusions who received cangrelor and those who received dual antiplatelets orally had similar radiographic and clinical outcomes.Conclusion: Low dose intravenous cangrelor is similar in safety and efficacy to oral antiplatelets in acute ischemic stroke in a small case series. Larger prospective studies on the efficacy, safety, and effect on procedure times of intravenous cangrelor in neurointervention are warranted.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Safety of Low Dose Intravenous Cangrelor in Acute Ischemic Stroke: A Case Series

et al. 2021

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“…Prior studies have found intraprocedural thrombotic events and delays to coronary bypass surgery, which were reduced with cangrelor, to be associated with significant health care costs. 26,27 In conclusion, the reductions in ischemic events, and thus, the overall efficacy seen with cangrelor in this exploratory analysis of CHAMPION PHOENIX occurred early and during the period of time in which patients were being actively treated with cangrelor. These findings affirm the feasibility of the transition strategy for procedural cangrelor to oral maintenance P2Y 12 inhibition and provide evidence that supports the importance of potent platelet inhibition during PCI.…”

Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Ischemic Events Occur Early in Patients Undergoing Percutaneous Coronary Intervention and Are Reduced With Cangrelor: Findings From CHAMPION PHOENIX

Cavender

Harrington

Stone

et al. 2022

Circ: Cardiovascular Interventions

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Background: Thrombotic events are reduced with cangrelor, an intravenous P2Y 12 inhibitor. We sought to characterize the timing, number, and type of early events (within 2 hours of randomization) in CHAMPION PHOENIX (A Clinical Trial Comparing Cangrelor to Clopidogrel Standard of Care Therapy in Subjects Who Require Percutaneous Coronary Intervention). Methods: CHAMPION PHOENIX was a double-blind, placebo-controlled trial that randomized patients undergoing percutaneous coronary intervention to cangrelor or clopidogrel. For this analysis, we evaluated the efficacy of cangrelor in the first 2 hours postrandomization with regards to the primary end point (death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis). Sensitivity analyses were performed evaluating a secondary, post hoc end point (death, Society of Coronary Angiography and Intervention myocardial infarction, ischemia-driven revascularization, or Academic Research Consortium definite stent thrombosis). Results: The majority of events (63%) that occurred in the trial occurred within 2 hours of randomization. The most common early event was myocardial infarction; next were stent thrombosis, ischemia driven revascularization, and death. In the first 2 hours after randomization, cangrelor significantly decreased the primary composite end point compared with clopidogrel (4.1% versus 5.4%; hazard ratio, 0.76 [95% CI, 0.64–0.90], P =0.002). Similar findings were seen for the composite end point of death, Society of Coronary Angiography and Intervention myocardial infarction, ischemia-driven revascularization, or Academic Research Consortium stent thrombosis at 2 hours (0.9% versus 1.6%; hazard ratio, 0.57 [95% CI, 0.40–0.80], P =0.001). Between 2 and 48 hours, there was no difference in the primary composite end point (0.6% versus 0.5%; odds ratio, 1.17 [95% CI, 0.71–1.93]; P =0.53). Early (≤2 hours of randomization) GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) moderate or severe bleeding events were infrequent, and there was no significant difference with cangrelor compared with clopidogrel (0.2% [n=10] versus 0.1% [n=4]; adjusted odds ratio, 1.41 [95% CI, 0.37–5.40]; P =0.62). Conclusions: The reductions in ischemic events and overall efficacy seen with cangrelor in CHAMPION PHOENIX occurred early and during the period of time in which patients were being actively treated with cangrelor. These findings provide evidence that supports the importance of potent platelet inhibition during percutaneous coronary intervention. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01156571.

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Health Economic Evaluation of an Ultrathin, Bioresorbable-Polymer Sirolimus-Eluting Coronary Stent Compared to a Thin, Durable-Polymer Everolimus-Eluting Stent

Mattke¹,

Hanson²,

Dallmann³

et al. 2019

Cardiovascular Revascularization Medicine

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Cost implications of intraprocedural thrombotic events and bleeding in percutaneous coronary intervention: Results from the CHAMPION PHOENIX ECONOMICS Study

Abstract: IPTE and bleeding complications, though infrequent, are associated with substantial increased cost. These complications should be collected in economic assessments of PCI.

Cited by 6 publications

References 19 publications

Safety of Low Dose Intravenous Cangrelor in Acute Ischemic Stroke: A Case Series

Safety of Low Dose Intravenous Cangrelor in Acute Ischemic Stroke: A Case Series

Ischemic Events Occur Early in Patients Undergoing Percutaneous Coronary Intervention and Are Reduced With Cangrelor: Findings From CHAMPION PHOENIX

Health Economic Evaluation of an Ultrathin, Bioresorbable-Polymer Sirolimus-Eluting Coronary Stent Compared to a Thin, Durable-Polymer Everolimus-Eluting Stent

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