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Clinical use of cangrelor: a real-world multicenter experience from South Italy

Martino Pepe1, Claudio Larosa2, Plinio Cirillo3

  • 1Section of Cardiovascular Diseases, Department of Cardiothoracic (DAI), University of Bari, Bari, Italy - drmartinopepe@gmail.com.

Panminerva Medica
|June 1, 2021
PubMed

Insights

Cangrelor, an intravenous antiplatelet, was used in high-risk acute coronary syndrome patients. Bleeding and stent thrombosis rates were comparable to trials when analyzed in similar risk groups.

Area of Science:

  • Cardiology
  • Pharmacology
  • Interventional Cardiology

Background:

  • Dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitors is standard for acute coronary syndromes (ACS) or chronic coronary syndromes (CCS) after percutaneous coronary intervention (PCI).
  • Cangrelor, the first intravenous P2Y12 inhibitor, aims to improve upon oral agents, but real-world data are limited.
  • This study investigates the routine clinical use and outcomes of cangrelor in Italian interventional centers.

Purpose of the Study:

  • To evaluate the real-world clinical use of cangrelor in patients undergoing PCI.
  • To assess in-hospital clinical outcomes, including mortality and bleeding events.
  • To compare outcomes in a subgroup of patients meeting CHAMPION Phoenix trial criteria.

Main Methods:

  • A total of 241 consecutive patients (196 ACS, 45 CCS) treated with cangrelor during PCI were enrolled.
  • Drug administration details and in-hospital outcomes were analyzed.
  • A subanalysis of a "CHAMPION-like" subpopulation was performed based on trial inclusion/exclusion criteria.

Main Results:

  • Cangrelor was primarily used in ACS patients with higher clinical risk and bleeding risk.
  • It was administered only to P2Y12 inhibitor-naïve patients, with specific switching protocols for clopidogrel, ticagrelor, or prasugrel.
  • In-hospital mortality was 10.0%, and GUSTO moderate/severe bleeding was 2.5%; bleeding rates were consistent with CHAMPION Phoenix in the comparable subpopulation.

Conclusions:

  • Cangrelor was predominantly used in ACS patients according to label indications.
  • Adverse outcomes were linked to the challenging clinical settings of utilization.
  • Bleeding and stent thrombosis rates were comparable to randomized trials when considering a similar risk profile subpopulation.
Abstract

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