替格瑞洛的ChampionPhoenixIII期临床试验结果.ppt

CHAMPIONPHOENIXDeepakL.Bhatt,MD,MPH,GreggW.Stone,MD,KennethW.DeepakL.Bhatt,MD,MPH,GreggW.Stone,MD,KennethW.Mahaffey,MD,C.MichaelGibson,MS,MD,Ph.GabrielSteg,MD,Mahaffey,MD,C.MichaelGibson,MS,MD,Ph.GabrielSteg,MD,ChristianHamm,MD,MatthewPrice,MD,SergioLeonardi,MD,ChristianHamm,MD,MatthewPrice,MD,SergioLeonardi,MD,DianneGallup,MS,MeredithTodd,SimonaSkerjanec,PharmD,DianneGallup,MS,MeredithTodd,SimonaSkerjanec,PharmD,HarveyD.White,DSc,andRobertA.Harrington,MD,onbehalfofHarveyD.White,DSc,andRobertA.Harrington,MD,onbehalfoftheCHAMPIONPHOENIXInvestigatorstheCHAMPIONPHOENIXInvestigators扰恫棕藉惯凭处洒喝衣谓匈舔抑岛篇摸菏晾少拦内闻窒勿鸯嫂捉窃卢舞躯替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果Dr.BhattAdvisoryBoard:MedscapeCardiology;BoardofDirectors:BostonVAResearchInstitute,SocietyofChestPainCenters;Chair:AmericanHeartAssociationGetWithTheGuidelinesScienceSubcommittee;Honoraria:AmericanCollegeofCardiology(Editor,ClinicalTrials,Cardiosource),DukeClinicalResearchInstitute(clinicaltrialsteeringcommittees),SlackPublications(ChiefMedicalEditor,CardiologyTodayIntervention),WebMD(CMEsteeringcommittees);Other:SeniorAssociateEditor,JournalofInvasiveCardiology;ResearchGrants:Amarin,AstraZeneca,Bristol-MyersSquibb,Eisai,Ethicon,Medtronic,SanofiAventis,TheMedicinesCompany;UnfundedResearch:FlowCo,PLxPharma,Takeda.Thispresentationincludesoff-labeland/orinvestigationalusesofdrugs,includingclopidogrelandcangrelor.TheCHAMPIONPHOENIXtrialwasfundedbyTheMedicinesCompany.Disclosures刺鞋邪鸣细中铣依勇匣羚缕傍阴倚衍试眉起粟觉芭滴排谁钙志怕灼大甲臣替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果AntiplateletTherapyAntiplatelettherapyisacriticalpartofcontemporaryPCI.Intheeraofaspirinandunfractionatedheparin,intravenousglycoproteinIIb/IIIainhibitionsignificantlyreducedimportantperiproceduralischemicevents,butsignificantlyincreasedbleeding.ADPreceptorantagonismwithoralagentswasalsoshowntoreduceischemiceventsinPCIandespeciallyACS.However,availableoralagentsarelimitedbytheirrelativelylongdurationofactionandbioavailability,whichmightbealiability:ifgivenpriortocoronaryangiographyandurgentoremergentCABGisdeemednecessary,insituationswhereabsorptionmaybeproblematic,suchaswithrapidtimestoPCI,inpatientswhoareintubated,nauseated,withSTEMI,orshock.HarringtonRA,etal.PURSUIT.NEJM1998DesaiNandBhattDL.PeriproceduralAntiplateletTherapy.JACCIntervention2010谰逊陶违什砸艇貉客稿簧柿爱划挽茧唁组杉谁颈完馈萨顿妙玖包氏拐痕简替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果CangrelorCangrelorisanintravenousADPreceptorantagonistthatisrapidlyacting,potent,andreversible,withreturnofnormalplateletfunctionwithinanhour.CangrelorwasstudiedpreviouslyintwolargePhase3PCItrials,CHAMPIONPCIandCHAMPIONPLATFORM.Neitherstudymetitsprimaryendpoint,butthesecondaryendpointofstentthrombosisat48hourswassignificantlyreducedinCHAMPIONPLATFORMandinaprespecifiedpooledanalysisofthetwotrials.Therewasnoexcessinseverebleeding.ThepotentialefficacysignalpromptedustolaunchtheCHAMPIONPHOENIXtrial.HarringtonRA,etal.CHAMPIONPCI.NEJM2009BhattDL,etal.CHAMPIONPLATFORM.NEJM2009WhiteHD,etal.Meta-AnalysisofCHAMPIONPCIandPLATFORM.AHJ2012荧耍呈营惜精腆铡穆赚嘉牢獭懂铂溢荫约钾忆棠苯尊洪贫宾刹破说姬绘编替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果CHAMPIONPHOENIXExecutiveCommitteeDeepakL.Bhatt,M.D.,M.P.H.(Co-PrincipalInvestigator)VABostonHealthcareSystem,BrighamandWomensHospital,andHarvardMedicalSchoolBoston,MARobertA.Harrington,M.D.(Co-PrincipalInvestigator)DepartmentofMedicine,StanfordUniversity,Stanford,CAC.MichaelGibson,M.S.,M.D.BethIsraelDeaconessMedicalCenter,DivisionofCardiology,Boston,MAChristianW.Hamm,M.D.KerckhoffHeartandThoraxCenter,BadNauheim,GermanyKennethW.Mahaffey,M.D.DukeClinicalResearchInstitute,Durham,NCMatthewJ.Price,M.D.ScrippsClinicandScrippsTranslationalScienceInstitute,LaJolla,CAPh.GabrielSteg,M.D.INSERMU-698,UniversitParis-Diderot,andHpitalBichat,Assistance-Publique-HpitauxdeParis,Paris,FranceGreggW.Stone,M.D.ColumbiaUniversityMedicalCenterandtheCardiovascularResearchFoundation,NewYork,NYHarveyD.White,D.Sc.AucklandCityHospital,Auckland,NewZealand汾吼州所墓励芦妙团穷雏催夹仟宏笼铰疵扇婿弄磕羡兆滔紧抖欠呢盘必叔替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果CHAMPIONPHOENIXDSMBFransVandeWerf,M.D.(Chair)UniversitairZiekenhuisGasthuisberg,BelgiumDavidP.Faxon,M.D.Brigham&WomensHospital,Dept.ofMedicineBoston,MAE.MagnusOhman,M.D.DukeUniversityMedicalCenter,Durham,NCFreekW.A.Verheugt,M.D.HeartcenterUniversityMedicalCenter,AmsterdamW.DouglasWeaver,M.D.HenryFordHospital,Detroit,MIJanG.P.Tijssen,Ph.D.(Statistician)DepartmentofCardiology,AcademicMedicalCenter-UniversityofAmsterdam,TheNetherlands猩泉碍房沁积其余脾筷猎蝎误窑依寅吝坡帮曝肌枷召孰舔樱阁缓认江划赂替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果CHAMPIONPHOENIXCECDuke Clinical Research InstituteREVIEWERSPhase1LucianaAmaganijanBrazilMoniqueAndersonNCAkshayBagaiNCRobertW.HarrisonNCPedroG.MelodeBarrosESilvaBrazilPhase2J.MatthewBrennanNCRenatoD.LopesNCChiaraMelloniNCPierluigiTricociNCLEADERSHIPKennethW.Mahaffey(Chair)SergioLeonardi(co-Chair)DianneGallup(LeadStatistician)MatthewD.Wilson(ProjectLeader)OPERATIONSStaceyMangum(Coordinator)LindaDowd(LeadCDA)DimitriosStournaras(LeadCDS)SachinVyas(LeadCTA)锌捧兑叔岭率箍栋甫肌溜驼炕鸵氖及纽僳查刹赴乔里奔桨盏兴宵掐聂檄涪替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果CHAMPIONPHOENIXAngiographicCoreLabCardiovascular Research FoundationMariaAlfonsoAntoinetteAllenGerardCondittRosaDeJesusChampikaDjurkovicSharwatJahanGregKaluzaElenaKonovalovaMitchellLustreKatharineLymberisDuvalMichelSofiaPapamitrouNicolettaPavloviciKharyPerrySairaPunjwaniConnieQiuRaquelSanchezEliasSanidasShawnaleeVassellDoueyWrightReviewers and Data Entry StaffLeadershipPhilippeGnreux(Director)SorinBrenerLauraLasalle媒圆捎瓷镰匣豪翟顾妨末僵轰钵虹困罩元震孰残厢恃谭腰煽阵钠猪增氓夺替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果12Countries153SitesUSAPolandGermanyAustriaThailandRussiaGeorgiaBulgariaBrazilCzechRepublicUSAPolandGermanyNewZealandAustriaItalyThailandRussiaGeorgiaBulgariaBrazilCHAMPIONPHOENIXAGlobalTrial体结坤绕掀弧晦伶组富穿揣惨惮甄肌将著钉徐痉脑切唇勘脏阳栖然婶游娄替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果CHAMPIONPHOENIXStudyDesignRandomized,double-blind,double-dummy,superiorityPrimaryefficacyendpoint:Death/MI/IDR/STat48hoursAdjustedfor600mgversus300mgclopidogreluseModifiedIntent-to-Treat(MITT)analysis(patientsactuallygotstudydrugandPCI)Keysecondaryendpoint:StentThrombosisat48hoursEfficacyendpointsalsoexaminedat30daysPrimarysafetyendpoint:GUSTOSevereBleedingat48hoursHarringtonRA,etal.CHAMPIONPCI.NEJM2009BhattDL,etal.CHAMPIONPLATFORM.NEJM2009WhiteHD,etal.Meta-AnalysisofCHAMPIONPCIandPLATFORM.AHJ2012臣什诵汽着则浦迷里顽衍肥爬减励贼瓮录痒润鳃饲帚菠熄娄弯杆炊事粪痞替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果CHAMPIONPHOENIXStudyDesign12to4hours0Cangrelor2bolus&infusion(30ug/kg;4ug/kg/min)Clopidogrel600mgoralCHAMPIONPHOENIXN=10,900MITTSA/NSTE-ACS/STEMIPatientsrequiringPCI1P2Y12inhibitornaveOR Placebo3oral(rightbeforePCIorrightafter,perphysician)Placebo2bolus&infusionPlacebooralPCI30OR Clopidogrel3(600mgor300mgoral,perphysician)1RandomizationoccurredoncesuitabilityforPCIwasconfirmedeitherbyangiographyorSTEMIdiagnosis.Doubleblindstudymedicationwasadministeredassoonaspossiblefollowingrandomization.2StudydrugInfusion(cangrelorormatchingplacebo)wascontinuedfor2-4hoursatthediscretionofthetreatingphysician.Attheendoftheinfusionpatientsreceivedaloadingdoseofclopidogrelormatchingplaceboandweretransitionedtomaintenanceclopidogreltherapy.3Clopidogrelloadingdose(ormatchingplacebo)wasadministeredasdirectedbytheinvestigator.Atthetimeofpatientrandomization,aclopidogrelloadingdoseof600mgor300mgwasspecifiedbytheinvestigator.MITT=modifiedintent-to-treat;NSTE-ACS=non-ST-elevationacutecoronarysyndrome;PCI=percutaneouscoronaryintervention;SA=stableangina;STEMI=ST-elevationMI.Rand茫唱闯滔蛤掉骤骂夯蠢埋单耿焚汗跳扣赠赛召军洋抢昧晤初频容鹰雪矮裹替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果Demographics,MITTCangrelor(N=5472)Clopidogrel(N=5470)Age,years6464Female28%27%Diabetesmellitus28%28%PatientTypeStableangina57%55%NSTE-ACS25%26%STEMI18%19%LoadingDose300mgclopidogrel26%26%600mgclopidogrel74%74%RegionUnitedStates37%37%Othercountries63%63%洞每已讣叫治昂脉娘咽鹅颈昂仓瘩歉万堂寻酶入僻宫融迄瓢浑忻丫甲罗肺替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果PrimaryEfficacyOutcomesat48Hours,MITTCangrelor(N=5472)Clopidogrel(N=5470)OR(95%CI)P-valuePrimaryAnalysisAdjusted1Death/MI/IDR/ST257/5470(4.7%)322/5469(5.9%)0.78(0.66,0.93)0.0051.Thelogisticmodelwasadjustedforbaselinestatusandclopidogreldose.Pvalueof0.006shownontheKMcurveislogrankpvalue.SecondaryEfficacyOutcomesat48Hours,MITTStentthrombosis(keysecondaryendpoint)46/5470(0.8%)74/5469(1.4%)0.62(0.43,0.90)0.01MI207/5470(3.8)255/5469(4.7)0.80(0.67,0.97)0.02Q-waveMI11/5470(0.2)18/5469(0.3)0.61(0.29,1.29)0.19IDR28/5470(0.5)38/5469(0.7)0.74(0.45,1.20)0.22Death18/5470(0.3)18/5469(0.3)1.00(0.52,1.92)0.99CVDeath18/5470(0.3)18/5469(0.3)1.00(0.52,1.92)0.99BhattDL,StoneGW,MahaffeyKW,etal.HarringtonRA.NEJM2013atwww.nejm.org藻桶篇猜截衙辜睁仕妆蝗助擦挠吟销颧堆克餐业嗅丈嫡科铡漱赶侮创且蒙替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果Death/MI/IDR/StentThrombosiswithin48HoursPatientatRiskHoursfromRandomizationCangrelor:547252335229522552235221522052175213Clopidogrel:547051625159515551525151515151475147cangrelorclopidogrel5.9%4.7%LogRankPValue=0.006EventRate(%)BhattDL,StoneGW,MahaffeyKW,etal.HarringtonRA.NEJM2013atwww.nejm.org硝伟登懦垦姬腔佰耕堤祖慧疫呜攫恿团鹰他例义犬谁油瓮鬃竣立痊煌渗颜替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果cangrelorclopidogrelLogRankPValue=0.01PatientatRiskHoursfromRandomizationCangrelor:547254265421541954195418541754165414Clopidogrel:5470539253895388538653855385538353831.4%0.8%EventRate(%)StentThrombosiswithin48HoursBhattDL,StoneGW,MahaffeyKW,etal.HarringtonRA.NEJM2013atwww.nejm.org塞酱葵展漂枪樊真渭畜一帚煮琳戍靳鹰匿厢稠配捕帘淹氛塘贷汤败貉拍勤替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果EfficacyOutcomesat30Days,MITTCangrelor(N=5472)Clopidogrel(N=5470)OR(95%CI)PValueDeath/MI/IDR/ST(primaryendpoint,adjusted)326/5462(6.0%)380/5457(7.0%)0.85(0.73,0.99)0.03Stentthrombosis71/5462(1.3%)104/5457(1.9%)0.68(0.50,0.92)0.01MI225/5462(4.1%)272/5457(5.0%)0.82(0.68,0.98)0.03Q-waveMI14/5462(0.3%)22/5457(0.4%)0.63(0.32,1.24)0.18IDR56/5462(1.0%)66/5457(1.2%)0.85(0.59,1.21)0.36Death60/5462(1.1%)55/5457(1.0%)1.09(0.76,1.58)0.64CVDeath48/5462(0.9%)46/5457(0.8%)1.04(0.69,1.57)0.84BhattDL,StoneGW,MahaffeyKW,etal.HarringtonRA.NEJM2013atwww.nejm.org修楷榷蜘浮江瑰婚丙揩埂绪静坍琳化此篱秀寅融椽芍春就抡跋眷烟仙撵蔬替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果OR95%CIPIntOverall0.79(0.67,0.93)Age750.71(0.50,1.02)0.55Age=600.79(0.66,0.94)0.89Weight100mg0.70(0.52,0.94)ClopidogrelLoadbeforePCIStart0.80(0.64,0.98)0.99ClopidogrelLoadafterPCIStart0.79(0.59,1.06)Cangrelorinfusion129minutes0.85(0.68,1.07)0.31Cangrelorinfusion129minutes0.72(0.56,0.92)Subgroups:Death/MI/IDR/STat48Hours(continued)5.01.00.2CangrelorBetterClopidogrelBetter走嗜斤规铭蛮鹤衫祟儿衬虾幽敛筛后完羌承卫钨铅管褪吐拌绿琴耘披昆扯替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果Non-CABGBleedingat48Hours,SafetyBleedingScaleCangrelor(N=5529)Clopidogrel(N=5527)OR(95%CI)PValueGUSTOSevere9(0.16%)6(0.11%)1.50(0.53,4.22)0.44GUSTOModerate22(0.4%)13(0.2%)1.69(0.85,3.37)0.13GUSTOSevere+Moderate31(0.6%)19(0.3%)1.63(0.92,2.90)0.09TIMIMajor5(0.1%)5(0.1%)1.00(0.29,3.45)0.999TIMIMinor9(0.2%)3(0.1%)3.00(0.81,11.10)0.08TIMIMajor+Minor14(0.3%)8(0.1%)1.75(0.73,4.18)0.2AnyBloodTransfusion25(0.5%)16(0.3%)1.56(0.83,2.93)0.16ACUITYMajor235(4.3%)139(2.5%)1.72(1.39,2.13)0.001ACUITYw/outhematoma42(0.8%)26(0.5%)1.62(0.99,2.64)0.05BhattDL,StoneGW,MahaffeyKW,etal.HarringtonRA.NEJM2013atwww.nejm.org俗赶桌翰诧段绣备升良瓜阑服库朱珍牧具练履搭疼猾媳净既庆撞而箭衷父替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果OR95%CIPIntOverall1.63(0.92,2.90)Age751.07(0.45,2.53)0.21Age=601.52(0.80,2.86)0.71Weight100mg1.49(0.74,3.03)ClopidogrelLoadbeforePCIStart1.24(0.58,2.66)0.25ClopidogrelLoadafterPCIStart2.53(0.98,6.54)Cangrelorinfusion129minutes1.71(0.81,3.59)0.85Cangrelorinfusion129minutes1.52(0.62,3.73)绍侠伯阵苛棺荣宠苇沏肃建丝捏篙惮里狱熄检货抉怀箱读冷伍军讳舒圈疏替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果SummaryofTreatmentEmergentAdverseEventsAdverseEventCangrelor(N=5529)Clopidogrel(N=5527)PValuePatientswithatleastoneAE20.2%19.1%0.13PatientswithatleastoneAEcausingstudydrugdiscontinuation0.5%0.4%0.21Transientdyspnea1.2%0.30.001BhattDL,StoneGW,MahaffeyKW,etal.HarringtonRA.NEJM2013atwww.nejm.org斧堕态走宴离嘉衔澎舔谷捷闽帅林范关时薄挨俱英局熟园讽诫碾窝混瘤汗替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果LimitationsAloadingdoseof600mghasbecomemorecommonthan300mgHowever,inthethreequartersofpatientswhoreceived600mg,thebenefitofcangrelorremainedstatisticallysignificantandwasnotattenuated.Itispossiblethebenefitswesawherewouldhavebeenattenuatedwithalongerdurationofpretreatment.Ofnote,theclopidogrelpretreatmentwasgiven“onthetable”asisconsistentwithmanypracticesaroundtheworldandinparticularintheUnitedStates.Importantly,prospectiverandomizedclinicaltrials,namelyCREDOandPRAGUE-8,didnotfindasignificantbenefitforclopidogrelpretreatment.Thebenefitsseenheremayalsohavebeenattenuatedhadprasugrelorticagrelorbeenusedinthecontrolarm.However,todate,thelargesttrialofprasugrelpretreatment,ACCOAST,wasterminatedbytheDSMBforlackofefficacyandexcessbleeding.Thus,oralpretreatment,whilebiologicallyappealingandintuitive,remainsunproveninprospectiverandomizedclinicaltrials.瞥配眼劣厢靡目祸后倒灸犹豺酪坛翘凛炉兵纸踢拜箕菏钙普微硬哗甥各匈替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果ConclusionsInCHAMPIONPHOENIX,intravenousADPreceptorantagonismwithcangrelorsignificantlyp=0.005)reducedthecompositeofdeath,myocardialinfarction,ischemia-drivenrevascularization,orstentthrombosisat48hours,witha22%oddsreduction.Thekeysecondaryendpointofstentthrombosiswasalsosignificantlyreduced,witha38%oddsreduction.Thebenefitwassustainedthrough30days.Therewasnoexcessinseverebleedingortransfusions.IntravenouscangrelormaybeanattractiveoptionacrossthefullspectrumofPCI,includingstableangina,NSTEMI,andSTEMI.长丑噎泳责陪靖定躯季嗓松秃淫弧踌讶乒耘屁姆树虏靴灾靖刃枝竭第基滨替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果ForFullDetails,PleaseGotowww.NEJM.orgBhattDL,StoneGW,MahaffeyKW,etal.HarringtonRA.NEJM2013atwww.nejm.org五淫琐反慷掀块终另颁绅房孪苑蝴凶哥舵剪劲堪雅陶苏讨短跃忽庞贸佐帐替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果THANKYOU!赖粉却乖隆教组撒新尼狭术霉鸽腊笆盖治睛中节蚌阻藻灾寇拦骚苹道兹导替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果BACKUPSLIDES尊关循盆竣奖界蔗轿绎吓苞熙炸咱聂裸冤瓶雨壁蛊酝晚舅孜凭馁壹样杆殃替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果CangrelorDirectplateletP2Y12receptorantagonistATPanalogueMW=800DaltonsParenteraladministrationT1/2=3to6minutesOffset=60minutesNNNNNHSCF3OHOHOOPOOPPOOOClClOOOS4Na+AngiolilloDJ,SchneiderDJ,BhattDL,etal.Pharmacodynamiceffectsofcangrelorandclopidogrel:theplateletfunctionsubstudyfromthecangrelorversusstandardtherapytoachieveoptimalmanagementofplateletinhibition(CHAMPION)trials.JThrombThrombolysis2012;34:44-55.奶疼扬耽签斜钝被东掏升集房腹涅亲嗡铀潍紫键晕牧练河烯湍兑翟列闰霓替格瑞洛的ChampionPhoenixIII期临床试验结果替格瑞洛的ChampionPhoenixIII期临床试验结果CHAMPIONPCI|PLATFORMPCI|allcomersPCI|58%ACS|onclopidogrelallowed|clopidogrel600mgadministeredatthestartofPCIinthecontrolarmPLATFORM|allcomersPCI|65%ACS|clopidogrelnave|clopidogrel600mgadministeredattheendofPCIinthecontrolarm12hours0PCI25Cangrelor30 g/kgthen4 g/kg/minCangrelor30 g/kgthen4 g/kg/minClopidogrel600mgoralClopidogrel600mgoralCHAMPIONPCIN=9000SA/UA/ACS/STEMIOnclopidogrelallow