PT  - JOURNAL ARTICLE
AU  - Sergio Leonardi
AU  - Adriano A M Truffa
AU  - Megan L Neely
AU  - Pierluigi Tricoci
AU  - Harvey D White
AU  - C Michael Gibson
AU  - Matthew Wilson
AU  - Gregg W Stone
AU  - Robert A Harrington
AU  - Deepak L Bhatt
AU  - Kenneth W Mahaffey
TI  - A novel approach to systematically implement the universal definition of myocardial infarction: insights from the CHAMPION PLATFORM trial
AID  - 10.1136/heartjnl-2012-303103
DP  - 2013 Sep 01
TA  - Heart
PG  - 1282--1287
VI  - 99
IP  - 17
4099  - http://heart.bmj.com/content/99/17/1282.short
4100  - http://heart.bmj.com/content/99/17/1282.full
SO  - Heart2013 Sep 01; 99
AB  - 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 (p<0.0001). 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). Conclusions 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.