Cangrelor versus clopidogrel at percutaneous coronary intervention

Registration and administrative information (PROSPERO field set)

Extracted values, and where each came from

One row per extracted value. Every row carries the value, the verbatim sentence it was read from, a resolvable link to the source, and whether the number was read or derived. Where any of those is absent the row says so rather than omitting the value.

References

Included studies

• — https://clinicaltrials.gov/study/NCT00305162
• — https://clinicaltrials.gov/study/NCT00385138
• — https://clinicaltrials.gov/study/NCT01156571

Regulatory documents

Methods and guidance

Sources

Risk of bias

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Not drawn, because there is nothing to draw it from.

GOSH

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Submission formats written to the figures directory, not embedded here because an uncompressed 600 dpi TIFF is tens of megabytes: EPS (vector, journal's first choice for line art) — gosh.eps, 2 KB; TIFF (uncompressed, 600 dpi -- journal fallback) — gosh.tiff, 5,537 KB.

Deliberately not drawn. Every subset meta-analysis of 3 trials is 7 points; a cloud that small cannot show the multimodality GOSH exists to reveal, and a reader would take the picture as evidence of its absence.

Trial-sequential analysis

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Submission formats written to the figures directory, not embedded here because an uncompressed 600 dpi TIFF is tens of megabytes: EPS (vector, journal's first choice for line art) — tsa.eps, 2 KB; TIFF (uncompressed, 600 dpi -- journal fallback) — tsa.tiff, 6,665 KB.

TSA boundaries depend entirely on a target information size that must be pre-specified. This review's protocol registers none, so any boundary drawn here would be a parameter chosen after seeing the data -- which is the practice TSA exists to protect against.

Meta-regression

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All raster formats were generated at build time from the same SVG as the graphic above (SHA-256, first 16 hex characters: 2316b730fa24744e), at 600 dpi for a 6-inch print width, on a white ground. They are not screenshots of the page and do not change with the theme you are reading in.

Submission formats written to the figures directory, not embedded here because an uncompressed 600 dpi TIFF is tens of megabytes: EPS (vector, journal's first choice for line art) — bubble.eps, 2 KB; TIFF (uncompressed, 600 dpi -- journal fallback) — bubble.tiff, 5,537 KB.

The protocol pre-specifies no moderator, and at k = 3 a meta-regression would be fitted on 3 points. Not drawn rather than drawn with a caveat: a bubble plot invites reading a slope, and there is no slope here that any reader should read.

Summary of findings

1. The pooled estimate for this outcome has been WITHDRAWN, so there is no estimate for a certainty rating to be about. Any rating this object still carries for this outcome was made about the withdrawn estimate and is not shown beside it.
2. Read this beside `whether the estimand was established`. That flag records that every contributing trial measures the same quantity. It records nothing about what that quantity was measured against -- whether the comparators are of one kind, whether each comparison was randomised, whether it was concurrent. The two questions were never separated. Named as P48 in PAGE-STANDARD.md v1.21.0 and swept by scripts/audit_mixed_contrast_pools.py.

Reproducibility artifact

This page CANNOT be rebuilt from what is recorded here: no canonical object is recorded and no registered commit is recorded. Each figure on the Analysis tab downloads as an SVG carrying exactly the values shown.

Other recorded qualifications

Statements this review records about the limits of what it establishes, which are not shown elsewhere on this page. They are reproduced from the object verbatim and are not summarised.

Paper

Each statement below cites the record it came from; those sources are listed at the end of every section. Where the record holds nothing, the section says so by name rather than being left out, so a procedure that was not carried out can be told from one that simply was never mentioned.

Title

Cangrelor versus clopidogrel at percutaneous coronary intervention¹

Abstract

Question. Does cangrelor reduce ischaemic events at PCI? The three CHAMPION trials answer versions of this, and the numbers this page used were not the ones they answered it .¹

Methods. estimates were pooled under a random-effects model with the REML estimator.²

Introduction

Background. This review asks: Does cangrelor reduce ischaemic events at PCI? The three CHAMPION trials answer versions of this, and the numbers this page used were not the ones they answered it . It pools 3 randomised trials, against clopidogrel. The outcome pooled is Death, myocardial infarction or ischaemia-driven revascularisation at 48 hours -- and stent thrombosis in one of the three trials.¹

Methods — eligibility criteria

not recorded on the page this object was built from¹

Methods — outcomes sought at every registered rank

Every registered rank -- primary, secondary and other -- was read for 3 of 3 contributing trials before any decision about which outcomes could be combined; each records the time it was read.¹

Methods — synthesis

For corrected composite 3component, a random-effects model was fitted with the REML estimator.¹

Results

Death, myocardial infarction or ischaemia-driven revascularisation at 48 hours -- and stent thrombosis in one of the three trials. These 3 trials are not pooled, and the reason is stated rather than the outcome being quietly omitted: The numerators and the denominators on this page come from different outcomes, on all three trials. Each row carried the primary composite's participant denominators -- 3,889 and 3,865; 2,654 and 2,641; 5,470 and 5,469, all exactly right -- against event counts of 8 and 5, 6 and 18, and 18 and 18. Those counts are not the composite's. They are all-cause mortality, a secondary outcome on every one of the three: CHAMPION-PCI's 'Individual Incidence of All-cause Mortality' is 8 against 5, CHAMPION-PLATFORM's 'Incidence of All-cause Mortality' is 6 against 18, and CHAMPION-PHOENIX's 18 against 18 is the death row of its stent-thrombosis/death/MI breakdown. The registry's own primary-composite counts are 290 and 276, 185 and 210, and 257 and 322 -- between one and two orders of magnitude larger than what the page used. A mortality numerator over a composite denominator is not a small error in a rate; it is a quantity that corresponds to nothing. And the correction reverses the conclusion, which is why this matters more than a tidiness complaint. Pooling the registry's own primary counts by DerSimonian-Laird gives OR 0.8955 (0.7526 to 1.0656), I-squared 64 per cent -- an interval that crosses no effect. The card published OR 0.81 (0.71 to 0.91), which excludes it. The page reported a significant benefit where the trials' own primary outcomes do not establish one. Separately and sufficient on its own: the composites are not the same. CHAMPION-PHOENIX's registered primary is 'The Composite Incidence of All-cause Mortality, Myocardial Infarction (MI), Ischemia-driven Revascularization (IDR) and stent thrombosis (ST)' -- four components. CHAMPION-PCI's and CHAMPION-PLATFORM's are mortality, MI and IDR: three. One whole component is present in one trial and absent from the other two, so even with correct counts these three would not share one estimand.¹

Noted on this pool. The 0.81 this page records as the withdrawn card's figure is also the published one. Steg et al., Lancet 2013 (PMID 24011551) -- a prespecified pooled analysis of PATIENT-LEVEL data from all three CHAMPION trials, 24,910 patients -- reports the primary composite at OR 0.81 (0.71 to 0.91). The withdrawal note on this outcome records that the card published OR 0.81 (0.71 to 0.91). The same value and the same interval. It does not undo the withdrawal. This object establishes that the card's own stored numerators were all-cause mortality counts set against the primary composite's denominators, on all three trials, and that is a real data defect. What it changes is the reading: the card's headline value appears to have been right while the counts beneath it could not produce it. A correct number standing on the wrong arithmetic is a provenance failure, not an accuracy one, and the withdrawal note currently reads as though the benefit itself were unsupported. From published aggregates this review can pool only CHAMPION-PCI and CHAMPION-PLATFORM on the three-component composite, because CHAMPION phoenix (NCT01156571) registers a four-component composite adding stent thrombosis -- its counts are recorded here, 257/5470 against 322/5469, so the exclusion is checkable. Steg et al. had patient-level data and could rebuild the three-component quantity for phoenix; that is not recoverable from aggregates. The two-trial pool is 0.965 (0.813 to 1.14) and crosses no difference where theirs does not. Prefer the published analysis. Three trials at patient level, prespecified, beats two trials of aggregate counts. Unresolved, and not decided here: whether this outcome's withdrawal note should be restated now that the withdrawn figure is corroborated by the literature. That is a content decision about a published number and belongs to the author. About the corrected three-component composite pool on this object, recorded here because that is where a reader arrives. The stored pooled result on this object names no effect measure. The `pooled` block holds point, CI LOW, CI HIGH and CI level and NO `measure` field: {"point": 0.9646, "CI LOW": 0.8132, "CI HIGH": 1.1442, "CI level": 95}. The outcome block above it says RR, so a reader who looks in the right place can recover it -- but the number itself travels without its unit, and it is compared elsewhere on this object against a published odds ratio. A risk ratio and an odds ratio are not interchangeable: away from the null the odds ratio is further from 1 than the risk ratio, so comparing ours against theirs makes our result look closer to no effect than a like-for-like comparison would. The direction of that error is knowable and is stated here; the size is not, because it depends on the event rate they pooled over, which this object does not hold. About the corrected three-component composite pool on this object, recorded here because that is where a reader arrives. Where this pool and the published one differ, the cause named on this object is not the one the evidence points . The cangrelor PCI programme's central controversy is the definition of the myocardial infarction component of its composite primary, which changed during the programme -- the third universal definition of myocardial infarction was published in 2012, mid-programme -- and the trials' results are sensitive to which definition is applied. A composite whose largest component is redefined is not the same endpoint before and after, and two syntheses applying different definitions will differ for that reason before any statistical one. This is recorded as the likely cause and not as an established one: establishing it needs the definition each synthesis applied, which is not on this object.²

The full model output for every pooled outcome -- the call, the estimator, the heterogeneity statistics and the back-transformed interval -- is stored verbatim on this review object at `results.by_outcome.<outcome>.r_output.verbatim`. It is not reproduced as an Extended data section in this article; an earlier version of this sentence said it was, and no such section exists.³

Comparison with published syntheses

Published syntheses were identified as follows. PubMed E-utilities, executed 2026-08-20. Query, counts and per-record disposition in ssot/cangrelor-pci-review/appraisal/the screen of published syntheses.json.¹

Limitations

Eligible trials that do not contribute: All three included registrations contribute to this review; none was dropped.¹

This review does not claim that the journal reports were consulted.²

1 claim(s) previously made about this review were corrected and the corrections are retained on the object rather than overwritten.³

What this review does not give a clinician: the number of events in each arm, any absolute effect or number needed to treat and any measure of harm. A relative effect cannot be turned into the benefit or the risk facing one patient without them, so this review can support a judgement about what these trials found and not a judgement about what to do.⁴

Software availability

Analyses were computed under R 4.6.0 with metafor 5.0.1.¹

Note on registration

No PROSPERO registration or protocol record is held on this object. That is not the same as knowing this review was not registered, and neither claim is made. It is recorded here as an absence so that a reader does not have to infer it from silence.¹

References

Figures

Trial characteristics

Not reported in this record

The items below were not written because the record does not hold what they would be composed from. They are named here so that an absence is not mistaken for an omission.