Use of Cangrelor in Older Patients: Findings from the itAlian pRospective Study on CANGrELOr Study

Outcome data on using cangrelor in older patients are limited. This post hoc analysis of the itAlian pRospective Study on CANGrELOr (ARCANGELO) study aims to assess bleeding and ischemic outcomes with the transition from cangrelor to any oral P2Y₁₂ inhibitors in age-stratified subgroups (≥75 years-older, <75 years-younger) of patients with acute coronary syndrome who underwent percutaneous coronary intervention (PCI). Of 995 patients, 215 (21.6%) were older, 115 of whom (11.6%) were aged ≥80 years. Presentation with ST-elevation myocardial infarction was less frequent in older than in younger patients (52.6% vs 62.1%, p = 0.0119). At 30 days after PCI, rates of the study's primary end point of overall bleeding defined according to the Bleeding Academic Research Consortium were not significantly different between the 2 age subgroups (4.6% in the younger vs 7.4% in the older, p = 0.1179). Rates of major adverse cardiac events, defined as the composite of death, myocardial infarction, ischemia-driven revascularization, and stent thrombosis, were significantly lower in younger than in older patients (0.9% vs 3.3%, p = 0.0170). Intraprocedural thrombotic events occurring in the 48 hours after PCI arose in similar proportions in the subgroups (1.4% vs 1.4%, p = 1.000). In conclusion, these data suggest that using cangrelor with transition to any oral P2Y12 inhibitor is a safe and effective antithrombotic treatment in older patients who undergo PCI for acute coronary syndrome in the setting of routine clinical practice. Clinical Trial Registration Number: NCT04471870.