Acute Coronary Syndrome, Atherosclerosis, Percutaneous Coronary Intervention
Conditions
Brief summary
The study is designed to compare the efficacy and safety profile of cangrelor to standard of care in patients require percutaneous coronary intervention (PCI).
Interventions
Over encapsulated tablets.
over-encapsulated clopidogrel (600 mg)
Sponsors
Study design
Eligibility
Inclusion criteria
Patients may be included in the study if they meet all of the following criteria: * Male or non-pregnant female at least 18 years of age * Patients undergoing percutaneous coronary intervention (PCI): 1. Stable angina (SA) patients with diagnostic coronary angiography within 90 days prior to randomization demonstrating atherosclerosis 2. Non-ST-Segment Elevation Acute Coronary Syndrome (NSTE-ACS) patients with diagnostic coronary angiography within 72 hours prior to randomization demonstrating atherosclerosis 3. ST-segment elevation myocardial infarction (STEMI) patients (diagnostic angiography not required) * Provide written informed consent
Exclusion criteria
Patients will be excluded from the study if any of the following
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The Composite Incidence of All-cause Mortality, Myocardial Infarction (MI), Ischemia-driven Revascularization (IDR) and Stent Thrombosis (ST) | 48 hours after randomization | Clinical Events Committee (CEC)-adjudicated results (modified intent-to-treat \[mITT\] population) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Individual Incidence of Stent Thrombosis (ST), Death, Myocardial Infarction (MI) and Ischemia-driven Revascularization (IDR) | 48 hours after randomization | CEC-adjudicated results (mITT population) |
| Incidence of Major/Minor Non-coronary Artery Bypass Graft (CABG)-Related Hemorrhage by Clinical Relevant Criteria - GUSTO Severe/Life-threatening, Moderate and Mild | 48 hours after randomization | GUSTO = Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries trial |
Countries
United States
Participant flow
Recruitment details
Date first patient enrolled: 30 Sep 2010 Date last patient completed: 14 Nov 2012 This trial enrolled the full spectrum of patients who required PCI (SA, NSTE-ACS, STEMI). Randomization occurred after confirmation of need for PCI (after diagnostic angiogram in all cases, except for STEMI patients). Patients were followed through 30-days.
Pre-assignment details
Due to the nature of the disease, STEMI patients were permitted to be randomized upon ECG confirmation and prior to confirmation of need for PCI (prior to diagnostic angiography). Therefore in some cases, STEMI patients did not require PCI and therefore did not receive all study drug.
Participants by arm
| Arm | Count |
|---|---|
| Cangrelor Treatment Arm Cangrelor was administered as a 30 µg/kg bolus followed by a 4.0 µg/kg/min cangrelor IV infusion for a minimum of 2 hours or until conclusion of the index procedure, whichever is longer. At the discretion of the treating physician, the infusion could be continued for a total duration of 4 hours.
Immediately after discontinuation of infusion, an oral transition dose of clopidogrel 600 mg was administered.
Patients also received oral placebo capsules, administered as soon as possible following randomization at investigator discretion. These capsules were designed to match the clopidogrel 600 mg or 300 mg loading dose. | 5,581 |
| Clopidogrel Treatment Arm Oral clopidogrel was administered as soon as possible following randomization at investigator discretion at a loading dose of either 600 mg or 300 mg as specified by the investigator.
Patients in the clopidogrel treatment arm received IV placebo for 2 hours or end of the PCI procedure, whichever was longer. At the discretion of the treating physician, the infusion could be continued for a total duration of 4 hours.
At the end of IV placebo infusion, patients were given oral placebo capsules matching the oral clopidogrel transition dose. | 5,564 |
| Total | 11,145 |
Baseline characteristics
| Characteristic | Cangrelor Treatment Arm | Clopidogrel Treatment Arm | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 2689 Participants | 2662 Participants | 5351 Participants |
| Age, Categorical Between 18 and 65 years | 2892 Participants | 2902 Participants | 5794 Participants |
| Age, Continuous | 64.0 years STANDARD_DEVIATION 11 | 63.8 years STANDARD_DEVIATION 11 | 63.9 years STANDARD_DEVIATION 11 |
| Region of Enrollment Austria | 302 participants | 300 participants | 602 participants |
| Region of Enrollment Brazil | 78 participants | 80 participants | 158 participants |
| Region of Enrollment Bulgaria | 169 participants | 167 participants | 336 participants |
| Region of Enrollment Czech Republic | 814 participants | 816 participants | 1630 participants |
| Region of Enrollment Georgia | 744 participants | 741 participants | 1485 participants |
| Region of Enrollment Germany | 243 participants | 251 participants | 494 participants |
| Region of Enrollment Italy | 311 participants | 310 participants | 621 participants |
| Region of Enrollment New Zealand | 22 participants | 23 participants | 45 participants |
| Region of Enrollment Poland | 352 participants | 350 participants | 702 participants |
| Region of Enrollment Russian Federation | 296 participants | 286 participants | 582 participants |
| Region of Enrollment Thailand | 151 participants | 151 participants | 302 participants |
| Region of Enrollment United States | 2099 participants | 2089 participants | 4188 participants |
| Sex: Female, Male Female | 1599 Participants | 1522 Participants | 3121 Participants |
| Sex: Female, Male Male | 3982 Participants | 4042 Participants | 8024 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 5,529 | 0 / 5,527 |
| serious Total, serious adverse events | 122 / 5,529 | 105 / 5,527 |
Outcome results
The Composite Incidence of All-cause Mortality, Myocardial Infarction (MI), Ischemia-driven Revascularization (IDR) and Stent Thrombosis (ST)
Clinical Events Committee (CEC)-adjudicated results (modified intent-to-treat \[mITT\] population)
Time frame: 48 hours after randomization
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cangrelor Treatment Arm | The Composite Incidence of All-cause Mortality, Myocardial Infarction (MI), Ischemia-driven Revascularization (IDR) and Stent Thrombosis (ST) | 257 participants |
| Clopidogrel Treatment Arm | The Composite Incidence of All-cause Mortality, Myocardial Infarction (MI), Ischemia-driven Revascularization (IDR) and Stent Thrombosis (ST) | 322 participants |
Incidence of Major/Minor Non-coronary Artery Bypass Graft (CABG)-Related Hemorrhage by Clinical Relevant Criteria - GUSTO Severe/Life-threatening, Moderate and Mild
GUSTO = Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries trial
Time frame: 48 hours after randomization
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Cangrelor Treatment Arm | Incidence of Major/Minor Non-coronary Artery Bypass Graft (CABG)-Related Hemorrhage by Clinical Relevant Criteria - GUSTO Severe/Life-threatening, Moderate and Mild | GUSTO severe or moderate | 31 participants |
| Cangrelor Treatment Arm | Incidence of Major/Minor Non-coronary Artery Bypass Graft (CABG)-Related Hemorrhage by Clinical Relevant Criteria - GUSTO Severe/Life-threatening, Moderate and Mild | TIMI minor | 9 participants |
| Cangrelor Treatment Arm | Incidence of Major/Minor Non-coronary Artery Bypass Graft (CABG)-Related Hemorrhage by Clinical Relevant Criteria - GUSTO Severe/Life-threatening, Moderate and Mild | GUSTO moderate | 22 participants |
| Cangrelor Treatment Arm | Incidence of Major/Minor Non-coronary Artery Bypass Graft (CABG)-Related Hemorrhage by Clinical Relevant Criteria - GUSTO Severe/Life-threatening, Moderate and Mild | TIMI major or minor | 14 participants |
| Cangrelor Treatment Arm | Incidence of Major/Minor Non-coronary Artery Bypass Graft (CABG)-Related Hemorrhage by Clinical Relevant Criteria - GUSTO Severe/Life-threatening, Moderate and Mild | TIMI major | 5 participants |
| Cangrelor Treatment Arm | Incidence of Major/Minor Non-coronary Artery Bypass Graft (CABG)-Related Hemorrhage by Clinical Relevant Criteria - GUSTO Severe/Life-threatening, Moderate and Mild | Any blood transfusion | 25 participants |
| Cangrelor Treatment Arm | Incidence of Major/Minor Non-coronary Artery Bypass Graft (CABG)-Related Hemorrhage by Clinical Relevant Criteria - GUSTO Severe/Life-threatening, Moderate and Mild | GUSTO severe/life threatening | 9 participants |
| Clopidogrel Treatment Arm | Incidence of Major/Minor Non-coronary Artery Bypass Graft (CABG)-Related Hemorrhage by Clinical Relevant Criteria - GUSTO Severe/Life-threatening, Moderate and Mild | Any blood transfusion | 16 participants |
| Clopidogrel Treatment Arm | Incidence of Major/Minor Non-coronary Artery Bypass Graft (CABG)-Related Hemorrhage by Clinical Relevant Criteria - GUSTO Severe/Life-threatening, Moderate and Mild | GUSTO severe/life threatening | 6 participants |
| Clopidogrel Treatment Arm | Incidence of Major/Minor Non-coronary Artery Bypass Graft (CABG)-Related Hemorrhage by Clinical Relevant Criteria - GUSTO Severe/Life-threatening, Moderate and Mild | GUSTO moderate | 13 participants |
| Clopidogrel Treatment Arm | Incidence of Major/Minor Non-coronary Artery Bypass Graft (CABG)-Related Hemorrhage by Clinical Relevant Criteria - GUSTO Severe/Life-threatening, Moderate and Mild | GUSTO severe or moderate | 19 participants |
| Clopidogrel Treatment Arm | Incidence of Major/Minor Non-coronary Artery Bypass Graft (CABG)-Related Hemorrhage by Clinical Relevant Criteria - GUSTO Severe/Life-threatening, Moderate and Mild | TIMI major | 5 participants |
| Clopidogrel Treatment Arm | Incidence of Major/Minor Non-coronary Artery Bypass Graft (CABG)-Related Hemorrhage by Clinical Relevant Criteria - GUSTO Severe/Life-threatening, Moderate and Mild | TIMI minor | 3 participants |
| Clopidogrel Treatment Arm | Incidence of Major/Minor Non-coronary Artery Bypass Graft (CABG)-Related Hemorrhage by Clinical Relevant Criteria - GUSTO Severe/Life-threatening, Moderate and Mild | TIMI major or minor | 8 participants |
Individual Incidence of Stent Thrombosis (ST), Death, Myocardial Infarction (MI) and Ischemia-driven Revascularization (IDR)
CEC-adjudicated results (mITT population)
Time frame: 48 hours after randomization
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Cangrelor Treatment Arm | Individual Incidence of Stent Thrombosis (ST), Death, Myocardial Infarction (MI) and Ischemia-driven Revascularization (IDR) | MI (myocardial infarction) | 207 participants |
| Cangrelor Treatment Arm | Individual Incidence of Stent Thrombosis (ST), Death, Myocardial Infarction (MI) and Ischemia-driven Revascularization (IDR) | Stent Thrombosis | 46 participants |
| Cangrelor Treatment Arm | Individual Incidence of Stent Thrombosis (ST), Death, Myocardial Infarction (MI) and Ischemia-driven Revascularization (IDR) | IDR (ischemia-driven revascularization) | 28 participants |
| Cangrelor Treatment Arm | Individual Incidence of Stent Thrombosis (ST), Death, Myocardial Infarction (MI) and Ischemia-driven Revascularization (IDR) | Death | 18 participants |
| Clopidogrel Treatment Arm | Individual Incidence of Stent Thrombosis (ST), Death, Myocardial Infarction (MI) and Ischemia-driven Revascularization (IDR) | IDR (ischemia-driven revascularization) | 38 participants |
| Clopidogrel Treatment Arm | Individual Incidence of Stent Thrombosis (ST), Death, Myocardial Infarction (MI) and Ischemia-driven Revascularization (IDR) | Stent Thrombosis | 74 participants |
| Clopidogrel Treatment Arm | Individual Incidence of Stent Thrombosis (ST), Death, Myocardial Infarction (MI) and Ischemia-driven Revascularization (IDR) | MI (myocardial infarction) | 255 participants |
| Clopidogrel Treatment Arm | Individual Incidence of Stent Thrombosis (ST), Death, Myocardial Infarction (MI) and Ischemia-driven Revascularization (IDR) | Death | 18 participants |