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Cangrelor Use in Routine Practice: A Two-Center Experience.

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|July 2, 2021
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Summary

Cangrelor, an intravenous P2Y12 inhibitor, was primarily used in high-risk ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention. Despite the high-risk population, cangrelor use was associated with a low rate of stent thrombosis.

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antiplatelet therapycangrelorpercutaneous coronary intervention

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Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Cangrelor is the first and only intravenous P2Y12-inhibitor.
  • It is indicated when oral P2Y12 inhibitors are not feasible during percutaneous coronary intervention (PCI).

Purpose of the Study:

  • To evaluate the initial use and outcomes of cangrelor in Dutch tertiary care centers.
  • To assess the safety and efficacy of cangrelor in a real-world, high-risk patient population.

Main Methods:

  • Retrospective analysis of 146 patients treated with cangrelor between March 2015 and April 2021.
  • Kaplan-Meier estimates for cumulative incidences of death, myocardial infarction, stent thrombosis, and bleeding at 48 hours and 30 days.
  • Cox regression models to identify predictors of 30-day mortality.

Main Results:

  • Cangrelor was predominantly used in ST-segment elevation myocardial infarction (STEMI) patients (84.2%), many requiring intensive support (54.8% CPR, 48.6% mechanical ventilation).
  • Cumulative incidence of all-cause death was 11.0% at 48h and 25.3% at 30 days.
  • Major bleeding occurred in 5.6% (48h) and 12.5% (30 days). Two stent thromboses (1.7%) occurred after 48 hours.
  • Cardiac arrest at presentation independently predicted 30-day mortality (aHR 5.20).

Conclusions:

  • Cangrelor is primarily utilized in high-risk STEMI patients undergoing PCI.
  • Despite the challenging patient profile, cangrelor demonstrated a low rate of definite stent thrombosis.
  • Cardiac arrest is a significant predictor of mortality in this patient group.