Intravenous platelet blockade with cangrelor during PCI.

Slides:

Advertisements

Présentations similaires

STREAM Fibrinolysis or Primary PCI in ST-segment Elevation Myocardial Infarction Armstrong P.W, et al. N Engl J Med 2013 ; 368 : Armstrong PW.

Advertisements

unstable angina undergoing PCI.

PRAGUE-8 PRAGUE-8 ESC 2007.

PLATO Ticagrelor versus clopidogrel in patients with acute coronary syndromes undergoing coronary artery bypass surgery. Held C et al. ACC 2010.

JPAD The Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes Trial. Efficacy of Low-Dose Aspirin Therapy for the Primary Prevention.

EXCELLENT The randomized comparison of 6-month vs 12-month duration of dual antiplatelet therapy after the implantation of drug eluting stent. Gwon H-C,

ON-TIME Intérêt de l’administration préhospitalière d’un bolus d’anti-GPIIb/IIIa à la phase aiguë d’un infarctus du myocarde traité par angioplastie coronaire.

FUTURA/OASIS-8 Low versus standard dose unfractionned heparin for percutaneous coronary intervention in acute coronary syndrome patients treated with fondaparinux.

VALIANT Efficacité et tolérance d’un antagoniste des récepteurs de l’angiotensine II (valsartan) après un infarctus du myocarde compliqué de dysfonction.

Prévention de la mortalité de l’IDM aigu

ISAR-TEST 4 Intracoronary stenting and antirestenotic results : test efficacy of 3 limus-eluting stents Mehilli J et al.

CLEAR PLATELETS Variabilité génétiquement déterminée de l’effet du clopidogrel Influence du polymorphism du CYP2C19 sur les effets antiplaquettaires du.

GRACE The Global Registry of Acute Coronary Events Montalescot G et al.

COURAGE Nuclear Differential Improvement in Stress Myocardial Perfusion Ischemia following Percutaneous Coronary Intervention as compared with Optimal.

ATOLL Acute STEMI treated with primary PCI and intravenous enoxaparin or UFH to lower ischemic and bleeding events at short and long-term follow-up. Montalescot.

ABOARD* Essai multicentrique randomisé comparant une stratégie invasive immédiate versus différée chez des patients présentant un syndrome coronarien aigu.

Caractéristiques patients à l’inclusion

ELEVATE-TIMI 56 Increasing clopidogrel based on CYP2C19 genotype in patients with cardiovascular disease. Mega JL et al. AHA 2011.

PEACE* Prévention par un IEC** (trandolapril) des accidents évolutifs graves chez des coronariens stables à fonction systolique ventriculaire gauche conservée.

ATLAS ACS 2 -TIMI 51 Anti-Xa therapy to lower cardiovascular events in addition to standard therapy in subjects with acute coronary syndrome.  Présentée.

TITRATION DU CLOPIDOGREL Tailored Clopidogrel Loading Dose according to Platelet Reactivity Monitoring Decrease Early Stent Thrombosis. Paganelli F et.

Apixaban versus warfarin in patients with atrial fibrillation

Revascularisation coronaire prophylactique avant chirurgie vasculaire

SYNTAX The synergy between percutaneous coronary intervention with TAXUS and cardiac surgery. Primary endpoint results at one year in the randomized cohort.

Registre MATRIX Long term safety of DES (drug eluting stents) in off-label use : results of the MATRIX registry. Dangas G.D et al. American College of.

TRITON-TIMI 38 Intensive oral antiplatelet therapy for reduction of ischaemic events including stent thrombosis in patients with acute coronary syndromes.

ISAR-REACT Anti-GPIIbIIIa (abciximab) en complément d’une dose de charge en clopidogrel avant angioplastie avec mise en place d’une endoprothèse coronaire.

EXPLORE-Xa Betrixaban Compared With Open‑Label Dose-Adjusted Warfarin in Patients With Non-Valvular Atrial Fibrillation. Ezekowitz MD et al. ACC 2010.

TRA-CER Vorapaxar, a platelet thrombin receptor antagonist, in acute coronary syndromes. Mahaffey KW et al . AHA 2011.

ISAR REACT 3A A trial of reduced dose of unfractioned heparin in biomarker negative patients undergoing percutaneous coronary intervention. Schulz S et.

un infarctus du myocarde récent.

TRIANA Tratamiento del infarto agudo de miocardio en ancianos Bueno H et al.

Platelet inhibition with cangrelor in patients undergoing PCI.

PRODIGY Prolonging dual antiplatelet treatment after grading stent-induced intimal hyperplasia study Valgimigli M et al. ESC 2011.

ROCKET AF Rivaroxaban Once-daily oral direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in Atrial.

Mass-DAC Drug-Eluting and Bare Metal Stenting in Diabetes Mellitus : Results from the Mass-DAC Registry. Mauri L et al. AHA 2008.

TRITON-TIMI 38 Evaluation of Prasugrel Compared with Clopidogrel in Patients with Acute Coronary Syndromes and Planned Percutaneous Coronary Intervention:

PRAGUE 7 Primary angioplasty in patients from general hospital transported to cathlab units with/without emergency thrombolysis Widimski P et al.

EARLY-ACS Inhibition de la glycoprotéine IIb/IIIa dans le syndrome coronarien aigu sans sus-décalage de ST Newby K et al. ACC Anti-GPIIb/IIIa précoce.

NORDISTEMI Norwegian study on district treatment of ST-elevation myocardial infarction Halvorsen S. et al.

Tests d’évaluation de la réactivité plaquettaire

TRITON-TIMI 38 Trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infraction.

AVERROES Apixaban versus acetylsalicylic acid (ASA) to reduce the risk of stroke Connolly S et al. ESC 2010.

Revascularisation coronaire : ATL-endoprothèses ou chirurgie ?

AIDA STEMI The abciximab intracoronary versus intravenously drug application in ST-elevation myocardial infarction (AIDA STEMI). Thiele H et al. AHA 2011.

ISAR-REACT 4 The abciximab intracoronary versus intravenously drug application in ST-elevation myocardial infarction (AIDA STEMI). Kastrati A et al. AHA.

ICTUS Comparaison entre revascularisation coronaire précoce

OASIS-5 Comparaison du fondaparinux à l’énoxaparine dans le syndrome coronarien aigu Comparison of fondaparinux and enoxaparin in acute coronary syndromes.

Prasugrel vs Clopidogrel for Patients managed with unstable angina or non-ST-segment elevation myocardial infarction with or without angiography : a secondary,

RE-COVER Dabigatran versus warfarine dans le traitement d’un accident thrombo-embolique veineux Schulman S et al. N Engl J Med 2009 ;361: Dabigatran.

Clopidogrel with aspirin in acute minor stroke or transient ischemic attack CHANCE Wang Y et al. N Engl J Med 2013 ;369:11-19.

CHARISMA Analyse post-hoc Complications hémorragiques de l’association clopidogrel + aspirine chez les patients avec maladie vasculaire stable ou avec.

LODOCO Low Dose Colchicine for Secondary Prevention of Cardiovascular Disease Nidorf M et al. AHA 2012.

FREEDOM Strategies for Multivessel Revascularization in Patients with Diabetes N Engl J Med 2012 DOI : /NEJMoa Farkouh ME et al. AHA 2012.

Reduction of stent thrombosis in patients with acute coronary syndromes treated with rivaroxaban in ATLAS-ACS TIMI 51 ATLAS ACS 2 –TIMI 51 * Gibson CM.

Host-ASSURE Adjunctive Cilostazol vs double dose clopidogrel after PCI with drug eluting stent Hyo-Soo K et al. ACC 2012.

TRA 2° P Vorapaxar in the secondary prevention in atherothrombotic events Morrow DA et al. N Engl J Med 2012 ; 366 : Morrow DA et al. ACC 2012.

CHARISMA Clopidogrel + aspirine contre aspirine seule pour la prévention des accidents athérothrombotiques. Bhatt DL et al. N Engl J Med 2006;354:

Aspirin in Patients Undergoing Non Cardiac Surgery POISE 2 Devereaux PJ et al. NEJM 2014;370:

ARISTOTLE Apixaban versus warfarine dans la fibrillation atriale

POISE-2 Aspirin in patients undergoing noncardiac surgery ACC Devereaux P.J, et al. N Engl J Med 2014 ; 370 :

Recombinant Administration of Ticagrelor in the cath lab or in the ambulance for new ST elevation myocardial infarction to open the coronary artery ATLANTIC.

JPPP Low-dose aspirin for primary prevention of cardiovascular events in elderly patients with multiple atherosclerotic risk factors. A randomized control.

Prasugrel vs Clopidogrel for Acute Coronary Syndromes without Revascularization TRILOGY ACS Roe MT et al. N Engl J Med 2012 ; 367:

CHAMPION PHOENIX Effect of Platelet Inhibition with Cangrelor during PCI on Ischemic Events Bhatt D.L, et al. N Engl J Med 2013 Bhatt DL et al. ACC 2013.

ATLAS ACS 2 – TIMI 51 Anti-Xa therapy to lower cardiovascular events in addition to standard therapy in subjects with acute coronary syndrome Gibson CM.

ATLANTIC Administration of Ticagrelor in the cath lab or in the ambulance for new ST elevation myocardial infarction to open the coronary artery Montalescot.

ACCOAST Pretreatment with prasugrel in non-ST elevation acute coronary syndromes ESC 2013 Montalescot G, et al. N Engl J Med 2013.

Strategies for Multivessel Revascularization in Patients with Diabetes

TRA 2° P Vorapaxar in the secondary prevention in atherothrombotic events Morrow DA et al. N Engl J Med 2012 ; 366 : Morrow DA et al. ACC 2012.

Transcription de la présentation:

Intravenous platelet blockade with cangrelor during PCI. CHAMPION-PLATFORM Cangrelor : 1er anti-agrégant plaquettaire injectable de la classe des thiénopyridines dans le mois suivant une ATL Intravenous platelet blockade with cangrelor during PCI. Bhatt DL et al. N Engl J Med 2009;361:2330-41

Méthodologie CHAMPION-PLATFORM Objectif Etude Critères d’inclusion Evaluer l’efficacité du cangrelor, 1er antagoniste direct et réversible (< 1 h) des récepteurs plaquettaires de l’ADP (P2Y12), contre clopidogrel, pour la prévention des évènements cardiovasculaires graves dans le mois suivant une ATL avec ou sans endoprothèse Etude Étude prospective, randomisée, double insu, multicentrique, internationale Critères d’inclusion Patients avec angor stable, SCA ST +, SCA ST – devant subir une ATL sans préparation par clopidogrel . CHAMPION-PLATFORM CHAMPION-PCI ATL : angioplastie transluminale percutanée Bhatt DL et al. N Engl J Med 2009;361:2330-41

Schéma de l’étude CHAMPION-PLATFORM R * + placebo oral Cangrelor IV bolus pendant 2 à 4 h (30g/kg) puis IV continu (4 g/kg/mn) * puis clopidogrel 600 mg/j (n = 2656) Critère de jugement principal Événements CV graves à J35 (décès CV, IDM, revasc. myoc.) CHAMPION-PLATFORM ATL pour angor stable, SCA ST +, SCA ST – sans préparation par clopidogrel n = 6400 R Clopidogrel 600 mg/j (n = 2645) Suivi 35 j * + placebo oral ** + placebo IV bolus puis IV continu Bhatt DL et al. N Engl J Med 2009;361:2330-41

Caractéristiques des patients Âge moyen 63 ans Hommes 73 % Diabète de type 2 31 % Monotronculaire 83 % SCA 94 % Endoprothèses actives 38 % CHAMPION-PLATFORM CHAMPION-PCI Bhatt DL et al. N Engl J Med 2009;361:2330-41

Résultats CHAMPION-PLATFORM Critère principal : événements cardiovasculaires graves à J35 Taux cumulé évts CV graves* 8,9 % p = ns cangrelor clopidogrel 9,6 % CHAMPION-PLATFORM CHAMPION-PCI *décès CV, IDM, revascularisation myocardique Bhatt DL et al. N Engl J Med 2009;361:2330-41

Conclusion CHAMPION-PLATFORM Cette étude ne montre aucun bénéfice précoce (35 j) de l’administration IV d’un AAP de la classe des thiénopyridines, le cangrelor, en cas d’ATL pour angor stable ou SCA. CHAMPION-PLATFORM CHAMPION-PCI Bhatt DL et al. N Engl J Med 2009;361:2330-41