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Published on: June 12, 2021
Cangrelor During Percutaneous Coronary Intervention in Patients With Cardiogenic Shock or Cardiac Arrest
Oskar Love Emilsson1, Moman A Mohammad2, Per Grimfjärd3
1Department of Cardiology, Lund University, Lund, Sweden.
Insights
Cangrelor treatment during percutaneous coronary intervention (PCI) in patients with myocardial infarction complicated by cardiogenic shock or cardiac arrest showed benefits. For cardiogenic shock patients, cangrelor reduced major adverse cardiovascular events (MACE) and mortality, but not for cardiac arrest patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Limited knowledge exists on cangrelor use during PCI for myocardial infarction with cardiogenic shock or cardiac arrest.
- Percutaneous coronary intervention (PCI) is a key treatment for acute myocardial infarction.
- Cardiogenic shock and cardiac arrest are severe complications of myocardial infarction, impacting patient outcomes.
Purpose of the Study:
- To investigate the efficacy and safety of cangrelor treatment during PCI in patients with myocardial infarction complicated by cardiogenic shock or cardiac arrest.
- To compare outcomes between patients receiving cangrelor and those not receiving it.
- To assess the impact of cangrelor on major adverse cardiovascular events (MACE), major bleeding, and all-cause mortality.
Main Methods:
- Retrospective analysis of patients undergoing PCI for myocardial infarction with cardiogenic shock or cardiac arrest from 2016-2022.
- Utilized data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR).
- Employed propensity score (PS)-matched analysis to compare outcomes between cangrelor and non-cangrelor groups.
Main Results:
- In PS-matched analysis for cardiogenic shock (n=994), cangrelor was associated with reduced MACE (RR 0.82) and mortality (RR 0.81), with absolute risk reductions of 8.9% for both.
- For cardiac arrest patients (n=1,138), cangrelor showed no significant benefit for MACE (RR 1.01) or mortality (RR 0.97).
- Cangrelor use was linked to increased major bleeding risk in cardiac arrest patients (RR 2.26), with an absolute risk increase of 3.5%.
Conclusions:
- Cangrelor administration during PCI in patients with cardiogenic shock is associated with improved outcomes, including lower MACE and mortality.
- In patients with myocardial infarction complicated by cardiac arrest, cangrelor did not demonstrate similar benefits and was associated with an increased risk of major bleeding.
- Further research may be warranted to refine patient selection for cangrelor therapy in complex myocardial infarction scenarios.
Background:
Little is known regarding treatment with cangrelor during percutaneous coronary intervention (PCI) in patients with myocardial infarction complicated by cardiogenic shock or cardiac arrest.
Objectives:
The aim of this study was to investigate the effects of such cangrelor treatment during PCI in patients with myocardial infarction complicated by cardiogenic shock or cardiac arrest.
Methods:
The study population included patients undergoing PCI (2016-2022) for myocardial infarction with cardiogenic shock or cardiac arrest from SCAAR (Swedish Coronary Angiography and Angioplasty Registry). Propensity score (PS)-matched groups were compared regarding major adverse cardiovascular events (MACE) within 30 days, in-hospital major bleeding, and all-cause mortality within 30 days.
Results:
A total of 3,014 patients with cardiogenic shock or cardiac arrest were included, 1,011 receiving and 2,003 not receiving cangrelor. In the PS-matched analysis regarding patients with cardiogenic shock (n = 994), the risk ratio (with vs without cangrelor) was 0.82 (95% CI: 0.71-0.94) for MACE, with an absolute risk reduction of 8.9 percentage points (95% CI: 2.7-15 percentage points) (number needed to treat = 12); 1.60 (95% CI: 0.93-2.76) for major bleeding; and 0.81 (95% CI: 0.70-0.94) for mortality, with an absolute risk reduction of 8.9 percentage points (95% CI: 2.7-15 percentage points) (number needed to treat = 12). In the PS-matched analysis regarding patients with cardiac arrest (n = 1,138), the risk ratio was 1.01 (95% CI: 0.87-1.18) for MACE; 2.26 (95% CI: 1.25-4.11) for major bleeding, with an absolute risk increase of 3.5 percentage points (95% CI: 1.0-5.7 percentage points); and 0.97 (95% CI: 0.83-1.13) for all-cause mortality.
Conclusions:
For patients with cardiogenic shock, administration of cangrelor during PCI was associated with a lower risk for both MACE and all-cause mortality. For patients with cardiac arrest, no such benefit was observed, and a higher risk for major bleeding was found.
