A novel approach to systematically implement the universal definition of myocardial infarction: insights from the CHAMPION PLATFORM trial
| Autor: | Harvey D. White, Sergio Leonardi, Deepak L. Bhatt, Kenneth W. Mahaffey, Adriano A. M. Truffa, Gregg W. Stone, Megan L. Neely, Matthew Wilson, C. Michael Gibson, Pierluigi Tricoci, Robert A. Harrington |
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| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Placebo Risk Assessment Sensitivity and Specificity chemistry.chemical_compound Cangrelor Percutaneous Coronary Intervention Internal medicine Medicine Creatine Kinase MB Form Humans cardiovascular diseases Myocardial infarction Acute Coronary Syndrome Aged Randomized Controlled Trials as Topic Interventional cardiology business.industry Percutaneous coronary intervention Middle Aged medicine.disease Adenosine Monophosphate Troponin Logistic Models chemistry Conventional PCI Cohort Physical therapy Purinergic P2Y Receptor Antagonists Female Myocardial infarction diagnosis Cardiology and Cardiovascular Medicine business Biomarkers |
| Zdroj: | Heart (British Cardiac Society). 99(17) |
| ISSN: | 1468-201X |
| Popis: | To reassess the efficacy of cangrelor efficacy using the universal definition of myocardial infarction (MI).We adopted a novel approach to systematically implement the universal definition of MI. Two physicians blinded to treatment allocation reviewed plots of CK-MB and troponin values in relation to time of randomisation and percutaneous coronary intervention (PCI) to identify patients with stable or falling biomarkers pre-PCI (ie, primary cohort), and those with post-PCI CK-MB elevations.The CHAMPION PLATFORM trial.Non-ST-elevation acute coronary syndromes (95%) and stable angina patients (5%).Cangrelor versus placebo.The efficacy of cangrelor compared with placebo using the reclassified events (type 4a MI) and the original clinical events committee-adjudicated (CEC PCI-MI) results was investigated.Of 5295 patients, 3406 (64.4%) were in the primary cohort. Type 4a MI occurred in 4.3% (226 events/5295 patients) while original CEC PCI-MI occurred in 6.5% (344 events/5295 patients), a significant difference (p0.0001). Using the reclassified MI events, the primary composite endpoint of death, MI, or ischaemia-driven revascularisation through 48 h occurred in 5.4% of patients (4.9% cangrelor, 6.0% placebo; OR 0.80; 95% CI 0.63 to 1.02) as opposed to 7.5% of the primary analyses (7.0% cangrelor, 8.0% placebo; OR 0.87; 95% CI 0.71 to 1.07).Systematic, strict implementation of the universal MI definition with emphasis on baseline assessment may enhance discrimination in detecting PCI-MI and may allow for more rigorous assessment of interventions in patients undergoing early PCI. |
| Databáze: | OpenAIRE |
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