A novel approach to systematically implement the universal definition of myocardial infarction: insights from the CHAMPION PLATFORM trial
- 23 February 2013
- Vol. 99 (17), 1282-1287
- https://doi.org/10.1136/heartjnl-2012-303103
Abstract
Objective To reassess the efficacy of cangrelor efficacy using the universal definition of myocardial infarction (MI). Design 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. Setting The CHAMPION PLATFORM trial. Patients Non-ST-elevation acute coronary syndromes (95%) and stable angina patients (5%). Interventions Cangrelor versus placebo. Main outcome measures 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. Results 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 (pConclusions 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.Keywords
This publication has 21 references indexed in Scilit:
- Comparison of the Prognosis of Spontaneous and Percutaneous Coronary Intervention–Related Myocardial InfarctionJournal of the American College of Cardiology, 2012
- American College of Cardiology/American Heart Association/European Society of Cardiology/World Heart Federation Universal Definition of Myocardial Infarction Classification System and the Risk of Cardiovascular DeathCirculation, 2012
- Antithrombotic Strategy in Non–ST-Segment Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention: Insights From the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) RegistryJACC: Cardiovascular Interventions, 2010
- Intravenous Platelet Blockade with Cangrelor during PCINew England Journal of Medicine, 2009
- Temporal Trends in the Use of Early Cardiac Catheterization in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes (Results from CRUSADE)The American Journal of Cardiology, 2006
- Enoxaparin vs Unfractionated Heparin in High-Risk Patients With Non–ST-Segment Elevation Acute Coronary Syndromes Managed With an Intended Early Invasive StrategyJAMA, 2004
- Creatine kinase-MB elevation after percutaneous coronary intervention predicts adverse outcomes in patients with acute coronary syndromesPublished by Oxford University Press (OUP) ,2004
- Minor Myocardial Damage and PrognosisCirculation, 2002
- Clinical outcomes after detection of elevated cardiac enzymes in patients undergoing percutaneous interventionJournal of the American College of Cardiology, 1999
- Inhibition of Platelet Glycoprotein IIb/IIIa with Eptifibatide in Patients with Acute Coronary SyndromesNew England Journal of Medicine, 1998